Weight loss in heart failure is associated with increased mortality only in non-obese patients without diabetes

Jacek T Niedziela, Bartosz Hudzik, Krzysztof Strojek, Lech Poloński, Mariusz Gąsior, Piotr Rozentryt, Jacek T Niedziela, Bartosz Hudzik, Krzysztof Strojek, Lech Poloński, Mariusz Gąsior, Piotr Rozentryt

Abstract

Background: Weight loss (WL) is an independent predictor of mortality in patients with heart failure (HF). Moderate WL is recommended for overweight or obese patients with type 2 diabetes mellitus (DM). The aim of this study was to assess the prognostic impact of body weight reduction on survival in patients with both HF with reduced ejection fraction (HFrEF) and DM.

Methods: The study comprised patients with HFrEF at the outpatient clinic. WL was defined as a body weight reduction of at least 7.5% during at least 6 months. Clinical features and 1 year mortality were analysed in WL and DM groups. Multivariate regression model was chosen to assess the predictive role of WL in HF patients with and without DM. The analysis regarding obesity before HF was also performed.

Results: The study comprised 777 patients with HFrEF. Mean age was 53.2 ± 9.2, 12.0% were women, mean EF was 23.7 ± 6.0 %, and New York Heart Association III or IV class, DM, and WL were found in 60.5%, 33.3%, and 47.1% patients, respectively. WL was more prevalent in diabetic patients, comparing with those without DM (53.7% vs. 43.8%, respectively, 0.01), and was associated with higher 1 year mortality only in non-diabetic group (17.6% for WL vs. 8.2% for non-WL, log-rank 0.001). In the multivariate analysis, WL was associated with a higher risk of 1 year mortality in non-diabetic patients: HR 1.76 (1.05-2.95), 0.03 and only in the subgroup without obesity: HR 2.35 (1.28-4.32), 0.006. In non-diabetic patients with obesity and in diabetic patients regardless of weight status, WL was not associated with worse prognosis (thereof, WL was excluded from the multivariate models).

Conclusions: Overall, WL in HFrEF has emerged as a predictor of unfavourable outcomes only in non-obese patients without DM. More importantly, this study has identified that the presence of DM (irrespective of weight status) or the presence of obesity in non-diabetic patients abolished the unfavourable impact of WL on long-term outcomes.

Keywords: Body wasting; Heart failure; Type 2 diabetes mellitus; Weight loss.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2019 The Authors Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Survival probability depending on the occurrence of weight loss (WL) in 1 year follow‐up in patients without diabetes mellitus (A) and with diabetes mellitus (B)—Kaplan–Meier curves.

References

    1. Lavie CJ, Ventura HO. Clinical implications of weight loss in heart failure. J Card Fail 2014;20:190–192.
    1. Lavie CJ, De Schutter A, Patel DA, Romero‐Corral A, Artham SM, Milani RV. Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the “obesity paradox”. J Am Coll Cardiol 2012;60:1374–1380.
    1. Kalantar‐Zadeh K, Kilpatrick RD, Kuwae N, Wu DY. Reverse epidemiology: a spurious hypothesis or a hardcore reality? Blood Purif 2005;23:57–63.
    1. Horwich TB, Fonarow GC, Clark AL. Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis 2018;61:151–156.
    1. Nagarajan V, Kohan L, Holland E, Keeley EC, Mazimba S. Obesity paradox in heart failure: a heavy matter. ESC Hear Fail 2016;3:227–234.
    1. Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2018;61:142–150.
    1. Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, et al. The obesity paradox in acute coronary syndrome: a meta‐analysis. Eur J Epidemiol 2014;29:801–812.
    1. Adamopoulos C, Meyer P, Desai RV, Karatzidou K, Ovalle F, White M, et al. Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: a propensity‐matched study. Eur J Heart Fail 2011;13:200–206.
    1. Zamora E, Lupón J, Enjuanes C, Pascual‐Figal D, de Antonio M, Domingo M, et al. No benefit from the obesity paradox for diabetic patients with heart failure. Eur J Heart Fail 2016. Jul 1;18:851–858.
    1. Anker SD, Ponikowski P, Varney S, Chua TP, Clark a L, Webb‐Peploe KM, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997;349:1050–1053.
    1. Doehner W, Erdmann E, Cairns R, Clark AL, Dormandy JA, Ferrannini E, et al. Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co‐morbidity: an analysis of the PROactive study population. Int J Cardiol 2012;162:20–26.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. Jul 14;37:2129–2200.
    1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014. Apr 1;63:1123–1133.
    1. Association AD . Standards of medical care in diabetes—2013. Diabetes Care 2013;36:S11–S66.
    1. Levey AS, Stevens LA, Schmid CH, Zhang Y(L), Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009. May 5;150:604–612.
    1. Osadnik T, Wasilewski J, Lekston A, Strzelczyk J, Kurek A, Gutowski AR, et al. Comparison of modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas in predicting long‐term outcomes in patients undergoing stent implantation due to stable coronary artery disease. Clin Res Cardiol 2014;103:569–576.
    1. Bertoni AG, Wagenknecht LE, Kitzman DW, Marcovina SM, Rushing JT, Espeland MA. Impact of the look AHEAD intervention on NT‐pro brain natriuretic peptide in overweight and obese adults with diabetes. Obesity (Silver Spring) 2012;20:1511–1518.
    1. Hudzik B, Rozentryt P, Lekston A, Poloński L. Not all fat is equal. J Am Coll Cardiol 2013;61:596–597.
    1. Berentzen T, Sørensen TIA. Effects of intended weight loss on morbidity and mortality: possible explanations of controversial results. Nutr Rev 2006;64:502–507.
    1. Look AHEAD Research Group . Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145–154.
    1. Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000;23:1499–1504.
    1. Wannamethee S, Shaper A, Lennon L. Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med 2005;165:1035–1040.
    1. Clerico A, Giannoni A, Vittorini S, Emdin M. The paradox of low BNP levels in obesity. Heart Fail Rev 2012;17:81–96.
    1. Neeland IJ, Winders BR, Ayers CR, Das SR, Chang AY, Berry JD, et al. Higher natriuretic peptide levels associate with a favorable adipose tissue distribution profile. J Am Coll Cardiol 2013;62:752–760.
    1. Changchien EM, Ahmed S, Betti F, Higa J, Kiely K, Hernandez‐Boussard T, et al. B‐type natriuretic peptide increases after gastric bypass surgery and correlates with weight loss. Surg Endosc 2011;25:2338–2343.
    1. Chen‐Tournoux A, Khan AM, Baggish AL, Castro VM, Semigran MJ, McCabe EL, et al. Effect of weight loss after weight loss surgery on plasma N‐terminal pro‐B‐type natriuretic peptide levels. Am J Cardiol 2010;106:1450–1455.
    1. Pocock SJ, McMurray JJV, Dobson J, Yusuf S, Granger CB, Michelson EL, et al. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J 2008;29:2641–2650.
    1. Trullàs JC, Formiga F, Montero M, Carrera‐Izquierdo M, Grau‐Amorós J, Chivite‐Guillén D, et al. Impact of weight loss on mortality in chronic heart failure: findings from the RICA Registry. Int J Cardiol 2012;168:306–311.
    1. Christensen HM, Kistorp C, Schou M, Keller N, Zerahn B, Frystyk J, et al. Prevalence of cachexia in chronic heart failure and characteristics of body composition and metabolic status. Endocrine 2013;43:626–634.
    1. Coats AJ, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, et al. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 1992;85:2119–2131.
    1. Tucker WJ, Lijauco CC, Hearon CM, Angadi SS, Nelson MD, Sarma S, et al. Mechanisms of the improvement in peak VO2 with exercise training in heart failure with reduced or preserved ejection fraction. Heart Lung Circ 2018;27:9–21.
    1. McAuley PA, Blaha MJ, Keteyian SJ, Brawner CA, Al Rifai M, Dardari ZA, et al. Fitness, fatness, and mortality: the FIT (Henry Ford exercise testing) project. Am J Med 2016;129:960–965.
    1. von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the journal of cachexia, sarcopenia and muscle: update 2017. J Cachexia Sarcopenia Muscle 2017;8:1081–1083.

Source: PubMed

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