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‘Obesity paradox’ present for all-cause mortality regardless of increased HF risk
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Despite an increased risk for HF among patients with obesity, there was a paradoxical decline in all-cause mortality, according to a meta-analysis published in Heart.
The best outcome was evident among patients with overweight, as shown in a U-shaped curve for CV mortality, according to the study.
“The current meta-analysis shows that obesity is associated with HF, and intentional weight loss leads to favorable cardiac remodeling in the obese,” Rajiv Mahajan, MD, lecturer at the University of Adelaide Medical School in Australia, and colleagues wrote. “It also demonstrates the least CV mortality in HF in the overweight group. Hence, this meta-analysis provides theoretical data with regard to potential prognostic benefit from intentional weight loss in obese patients with HF.”
Researchers analyzed data from 29 studies that reported on the prognostic impact and association between obesity and HF. These studies also reported on the impact of weight loss after bariatric surgery on myocardial function and cardiac structure among patients with obesity.
The outcomes of interest were the effect of BMI on CV and all-cause mortality in chronic HF, incidence of chronic HF across BMI categories and the impact of weight loss by bariatric surgery among patients with obesity on cardiac function and structure.
There was a J-curve relationship between BMI and the risk for HF, with the greatest risk seen among patients with morbid obesity (OR = 1.73; 95% CI, 1.3-2.31).
The lowest risk for CV mortality was seen among patients with overweight compared with the other groups (OR = 0.86; 95% CI, 0.79-0.94). No significant differences were seen across the other BMI groups.
Intentional weight loss through bariatric surgery among patients with obesity without established HF, known CAD or atrial fibrillation led to an improvement in left ventricular diastolic function (standard mean difference = 0.65; 95% CI, 0.38-0.91), a reduction in LV mass index (standard mean difference = –0.49; 95% CI, –0.73 to –0.26) and a reduction in left atrial size (standard mean difference = –0.39; 95% CI, –0.72 to –0.07).
“Given the burgeoning population incidence of HF, adequately powered and appropriately designed studies to assess the effects of intentional weight loss in obese patients with HF are urgently required,” Mahajan and colleagues wrote. – by Darlene Dobkowski
Disclosures: Mahajan reports his institution receives research funding, lecture and/or consultant fees on his behalf from Abbott and Medtronic. Please see the study for all other authors’ relevant financial disclosures.
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