Body mass index and mortality in heart failure: A meta-analysis
Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology . This meta-analysis...
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| creator | Oreopoulos, Antigone, MSc Padwal, Raj, MD, MSc Kalantar-Zadeh, Kamyar, MD, MPH, PhD Fonarow, Gregg C., MD, FACC Norris, Colleen M., PhD McAlister, Finlay A., MD, MSc |
| description | Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology . This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify studies with contemporaneous control groups (cohort, case-control, or randomized controlled trials) that examined the effect of obesity on all-cause and cardiovascular mortality. Two reviewers independently assessed studies for inclusion and performed data extraction. Results Nine observational studies met final inclusion criteria (total n = 28,209). Mean length of follow-up was 2.7 years. Compared to individuals without elevated BMI levels, both overweight (BMI ∼25.0-29.9 kg/m2 , RR 0.84, 95% CI 0.79-0.90) and obesity (BMI ∼≥30 kg/m2 , RR 0.67, 95% CI 0.62-0.73) were associated with lower all-cause mortality. Overweight (RR 0.81, 95% CI 0.72-0.92) and obesity (RR 0.60, 95% CI 0.53-0.69) were also associated with lower cardiovascular mortality. In a risk-adjusted sensitivity analysis, both obesity (adjusted HR 0.88, 95% CI 0.83-0.93) and overweight (adjusted HR 0.93, 95% CI 0.89-0.97) remained protective against mortality. Conclusions Overweight and obesity were associated with lower all-cause and cardiovascular mortality rates in patients with CHF and were not associated with increased mortality in any study. There is a need for prospective studies to elucidate mechanisms for this relationship. |
| doi_str_mv | 10.1016/j.ahj.2008.02.014 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69264233</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870308001543</els_id><sourcerecordid>3238098421</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-1c858ef3700f505cfd008b17a1e1e19d81755a325485ebb5c639b272d62fd2463</originalsourceid><addsrcrecordid>eNp9kluL1TAUhYMoznH0B_giBdG31p17q6CMgzcY8EF9Dmmyy6T2Miat2H9vyjk4MA-Sh5DNt_ZeWWxCnlKoKFD1qq_sdV8xgLoCVgEV98iBQqNLpYW4Tw4AwMpaAz8jj1Lq81OxWj0kZ7SWtRQNO5B372e_FaNNqQiTxz-FnXwxznGxQ1i2XCuu0cal6GwY1oivi4tixMWWdrLDlkJ6TB50dkj45HSfkx8fP3y__Fxeff305fLiqnRS86WkLk_EjmuAToJ0nc-mW6otxXwaX1MtpeVMilpi20qneNMyzbxinWdC8XPy8tj3Js6_VkyLGUNyOAx2wnlNRjVMCcZ5Bp_fAft5jdltMlSCkI2u9U7RI-XinFLEztzEMNq4GQpmz9b0Jmdr9mwNMJOzzZpnp85rO6K_VZzCzMCLE2CTs0MX7eRC-scxkJwx3WTuzZHDHNjvgNEkF3By6ENEtxg_h__aeHtH7YYwhTzwJ26Ybn9rUhaYb_sS7DsANQCVgvO_F4ioZw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1504597873</pqid></control><display><type>article</type><title>Body mass index and mortality in heart failure: A meta-analysis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Oreopoulos, Antigone, MSc ; Padwal, Raj, MD, MSc ; Kalantar-Zadeh, Kamyar, MD, MPH, PhD ; Fonarow, Gregg C., MD, FACC ; Norris, Colleen M., PhD ; McAlister, Finlay A., MD, MSc</creator><creatorcontrib>Oreopoulos, Antigone, MSc ; Padwal, Raj, MD, MSc ; Kalantar-Zadeh, Kamyar, MD, MPH, PhD ; Fonarow, Gregg C., MD, FACC ; Norris, Colleen M., PhD ; McAlister, Finlay A., MD, MSc</creatorcontrib><description>Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology . This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify studies with contemporaneous control groups (cohort, case-control, or randomized controlled trials) that examined the effect of obesity on all-cause and cardiovascular mortality. Two reviewers independently assessed studies for inclusion and performed data extraction. Results Nine observational studies met final inclusion criteria (total n = 28,209). Mean length of follow-up was 2.7 years. Compared to individuals without elevated BMI levels, both overweight (BMI ∼25.0-29.9 kg/m2 , RR 0.84, 95% CI 0.79-0.90) and obesity (BMI ∼≥30 kg/m2 , RR 0.67, 95% CI 0.62-0.73) were associated with lower all-cause mortality. Overweight (RR 0.81, 95% CI 0.72-0.92) and obesity (RR 0.60, 95% CI 0.53-0.69) were also associated with lower cardiovascular mortality. In a risk-adjusted sensitivity analysis, both obesity (adjusted HR 0.88, 95% CI 0.83-0.93) and overweight (adjusted HR 0.93, 95% CI 0.89-0.97) remained protective against mortality. Conclusions Overweight and obesity were associated with lower all-cause and cardiovascular mortality rates in patients with CHF and were not associated with increased mortality in any study. There is a need for prospective studies to elucidate mechanisms for this relationship.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2008.02.014</identifier><identifier>PMID: 18585492</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Body Mass Index ; Cardiology. Vascular system ; Cardiovascular ; Cause of Death ; Drug therapy ; Female ; Heart ; Heart attacks ; Heart Failure - mortality ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Male ; Medical sciences ; Mortality ; Obesity ; Obesity - complications ; Prognosis ; Reference Values ; Risk Assessment ; Studies ; Survival Analysis</subject><ispartof>The American heart journal, 2008-07, Vol.156 (1), p.13-22</ispartof><rights>Mosby, Inc.</rights><rights>2008 Mosby, Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jul 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-1c858ef3700f505cfd008b17a1e1e19d81755a325485ebb5c639b272d62fd2463</citedby><cites>FETCH-LOGICAL-c573t-1c858ef3700f505cfd008b17a1e1e19d81755a325485ebb5c639b272d62fd2463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870308001543$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20532279$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18585492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oreopoulos, Antigone, MSc</creatorcontrib><creatorcontrib>Padwal, Raj, MD, MSc</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD, FACC</creatorcontrib><creatorcontrib>Norris, Colleen M., PhD</creatorcontrib><creatorcontrib>McAlister, Finlay A., MD, MSc</creatorcontrib><title>Body mass index and mortality in heart failure: A meta-analysis</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology . This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify studies with contemporaneous control groups (cohort, case-control, or randomized controlled trials) that examined the effect of obesity on all-cause and cardiovascular mortality. Two reviewers independently assessed studies for inclusion and performed data extraction. Results Nine observational studies met final inclusion criteria (total n = 28,209). Mean length of follow-up was 2.7 years. Compared to individuals without elevated BMI levels, both overweight (BMI ∼25.0-29.9 kg/m2 , RR 0.84, 95% CI 0.79-0.90) and obesity (BMI ∼≥30 kg/m2 , RR 0.67, 95% CI 0.62-0.73) were associated with lower all-cause mortality. Overweight (RR 0.81, 95% CI 0.72-0.92) and obesity (RR 0.60, 95% CI 0.53-0.69) were also associated with lower cardiovascular mortality. In a risk-adjusted sensitivity analysis, both obesity (adjusted HR 0.88, 95% CI 0.83-0.93) and overweight (adjusted HR 0.93, 95% CI 0.89-0.97) remained protective against mortality. Conclusions Overweight and obesity were associated with lower all-cause and cardiovascular mortality rates in patients with CHF and were not associated with increased mortality in any study. There is a need for prospective studies to elucidate mechanisms for this relationship.</description><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cause of Death</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Failure - mortality</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Prognosis</subject><subject>Reference Values</subject><subject>Risk Assessment</subject><subject>Studies</subject><subject>Survival Analysis</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kluL1TAUhYMoznH0B_giBdG31p17q6CMgzcY8EF9Dmmyy6T2Miat2H9vyjk4MA-Sh5DNt_ZeWWxCnlKoKFD1qq_sdV8xgLoCVgEV98iBQqNLpYW4Tw4AwMpaAz8jj1Lq81OxWj0kZ7SWtRQNO5B372e_FaNNqQiTxz-FnXwxznGxQ1i2XCuu0cal6GwY1oivi4tixMWWdrLDlkJ6TB50dkj45HSfkx8fP3y__Fxeff305fLiqnRS86WkLk_EjmuAToJ0nc-mW6otxXwaX1MtpeVMilpi20qneNMyzbxinWdC8XPy8tj3Js6_VkyLGUNyOAx2wnlNRjVMCcZ5Bp_fAft5jdltMlSCkI2u9U7RI-XinFLEztzEMNq4GQpmz9b0Jmdr9mwNMJOzzZpnp85rO6K_VZzCzMCLE2CTs0MX7eRC-scxkJwx3WTuzZHDHNjvgNEkF3By6ENEtxg_h__aeHtH7YYwhTzwJ26Ybn9rUhaYb_sS7DsANQCVgvO_F4ioZw</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>Oreopoulos, Antigone, MSc</creator><creator>Padwal, Raj, MD, MSc</creator><creator>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creator><creator>Fonarow, Gregg C., MD, FACC</creator><creator>Norris, Colleen M., PhD</creator><creator>McAlister, Finlay A., MD, MSc</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>Body mass index and mortality in heart failure: A meta-analysis</title><author>Oreopoulos, Antigone, MSc ; Padwal, Raj, MD, MSc ; Kalantar-Zadeh, Kamyar, MD, MPH, PhD ; Fonarow, Gregg C., MD, FACC ; Norris, Colleen M., PhD ; McAlister, Finlay A., MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-1c858ef3700f505cfd008b17a1e1e19d81755a325485ebb5c639b272d62fd2463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cause of Death</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart Failure - mortality</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Prognosis</topic><topic>Reference Values</topic><topic>Risk Assessment</topic><topic>Studies</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oreopoulos, Antigone, MSc</creatorcontrib><creatorcontrib>Padwal, Raj, MD, MSc</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creatorcontrib><creatorcontrib>Fonarow, Gregg C., MD, FACC</creatorcontrib><creatorcontrib>Norris, Colleen M., PhD</creatorcontrib><creatorcontrib>McAlister, Finlay A., MD, MSc</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oreopoulos, Antigone, MSc</au><au>Padwal, Raj, MD, MSc</au><au>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</au><au>Fonarow, Gregg C., MD, FACC</au><au>Norris, Colleen M., PhD</au><au>McAlister, Finlay A., MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Body mass index and mortality in heart failure: A meta-analysis</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>156</volume><issue>1</issue><spage>13</spage><epage>22</epage><pages>13-22</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology . This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify studies with contemporaneous control groups (cohort, case-control, or randomized controlled trials) that examined the effect of obesity on all-cause and cardiovascular mortality. Two reviewers independently assessed studies for inclusion and performed data extraction. Results Nine observational studies met final inclusion criteria (total n = 28,209). Mean length of follow-up was 2.7 years. Compared to individuals without elevated BMI levels, both overweight (BMI ∼25.0-29.9 kg/m2 , RR 0.84, 95% CI 0.79-0.90) and obesity (BMI ∼≥30 kg/m2 , RR 0.67, 95% CI 0.62-0.73) were associated with lower all-cause mortality. Overweight (RR 0.81, 95% CI 0.72-0.92) and obesity (RR 0.60, 95% CI 0.53-0.69) were also associated with lower cardiovascular mortality. In a risk-adjusted sensitivity analysis, both obesity (adjusted HR 0.88, 95% CI 0.83-0.93) and overweight (adjusted HR 0.93, 95% CI 0.89-0.97) remained protective against mortality. Conclusions Overweight and obesity were associated with lower all-cause and cardiovascular mortality rates in patients with CHF and were not associated with increased mortality in any study. There is a need for prospective studies to elucidate mechanisms for this relationship.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>18585492</pmid><doi>10.1016/j.ahj.2008.02.014</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Body Mass Index Cardiology. Vascular system Cardiovascular Cause of Death Drug therapy Female Heart Heart attacks Heart Failure - mortality Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Male Medical sciences Mortality Obesity Obesity - complications Prognosis Reference Values Risk Assessment Studies Survival Analysis |
| title | Body mass index and mortality in heart failure: A meta-analysis |
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