Association of Body-Weight Fluctuation With Outcomes in Heart Failure With Preserved Ejection Fraction

Abstract

Aims: To investigate the relationship between body-weight fluctuation and risks of clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results:We measured intra-individual variations in body weight from baseline and follow-up visits in 1,691 participants with HFpEF from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. The primary endpoint was any cardiovascular events (a composite of death from cardiovascular disease, non-fatal myocardial infarction, aborted cardiac arrest, or hospitalization for HF). The body-weight fluctuation was measured according to average successive variability and high variability was defined as greater than or equal to the median. After adjustment for risk factors, mean body weight and weight change, each increase of 1 standard deviation in body-weight variability was significantly associated with increased risks of any cardiovascular events (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.15-1.33, P < 0.001). Patients with high variability had a 47% increased risk of any cardiovascular events and 27% increased risk of all-cause death compared with those with low variability. Such association was similar among patients with New York Heart Association functional class I/II vs. III/IV, obesity vs. non-obesity, and weight loss, gain vs. stability (the P-values for interaction were all insignificant). Conclusion: Among patients with HFpEF, body-weight fluctuation was associated with increased risks of cardiovascular events independent of traditional cardiovascular risk factors, and regardless of HF severity, baseline weight or weight change direction. Clinical Trial Registration: Aldosterone antagonist therapy for adults with heart failure and preserved systolic function (TOPCAT), https://ichgcp.net/clinical-trials-registry/NCT00094302" title="See in ClinicalTrials.gov">NCT00094302].

Keywords: body weight; fluctuation; heart failure; heart failure with preserved ejection fraction; outcome.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Li, Yu, Wu, Liang, Dong, Xue, Dong, Zhu and Huang.

Figures

Figure 1

Risk of outcomes in the high vs. low body-weight variability in multivariable model. The multivariable model was adjusted for diuretics, mean body weight, change in weight, age, sex, race, smoking status, diabetes status, atrial fibrillation, peripheral arterial disease, previous hospitalization for chronic heart failure, prior myocardial infarction, known stroke, chronic obstructive pulmonary disease, New York Heart Association class, systolic blood pressure, heart rate, ejection fraction, estimated glomerular filtration rate, number of weight measurement. HF, heart failure; HR, hazard ratio.

Figure 2

Body-weight variability and risk of any cardiovascular events for various subgroups in multivariable model. The multivariable model was adjusted for diuretics, mean body weight, change in weight, age, sex, race, smoking status, diabetes status, atrial fibrillation, peripheral arterial disease, previous hospitalization for chronic heart failure, prior myocardial infarction, known stroke, chronic obstructive pulmonary disease, NYHA class, systolic blood pressure, heart rate, ejection fraction, estimated glomerular filtration rate, number of weight measurement. NYHA, New York Heart Association; BMI, body mass index; HR, hazard ratio.