Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome

Alberto Aimo, James L. Januzzi, Giuseppe Vergaro, Aldo Clerico, Roberto Latini, Jennifer Meessen, Inder S. Anand, Jay N. Cohn, Jørgen Gravning, Thor Ueland, Ståle H. Nymo, Hans Peter Brunner-La Rocca, Antoni Bayes-Genis, Josep Lupón, Rudolf A. de Boer, Akiomi Yoshihisa, Yasuchika Takeishi, Michael Egstrup, Ida Gustafsson, Hanna K. GagginKai M. Eggers, Kurt Huber, Ioannis Tentzeris, Andrea Ripoli, Claudio Passino, Michele Emdin

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aims: Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods: In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson–Pollock and Gallagher equations. Results: Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion: In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

Original languageEnglish (US)
Pages (from-to)1751-1759
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Volume26
Issue number16
DOIs
StatePublished - Nov 1 2019

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Adipose Tissue
Heart Failure
Obesity
Biomarkers
Brain Natriuretic Peptide
Troponin T
Body Mass Index
Carcinogenesis
Cause of Death
Weights and Measures
Survival

Keywords

  • Obesity
  • heart failure
  • natriuretic peptides
  • prognosis
  • sST2
  • troponin

Cite this

Revisiting the obesity paradox in heart failure : Per cent body fat as predictor of biomarkers and outcome. / Aimo, Alberto; Januzzi, James L.; Vergaro, Giuseppe; Clerico, Aldo; Latini, Roberto; Meessen, Jennifer; Anand, Inder S.; Cohn, Jay N.; Gravning, Jørgen; Ueland, Thor; Nymo, Ståle H.; Brunner-La Rocca, Hans Peter; Bayes-Genis, Antoni; Lupón, Josep; de Boer, Rudolf A.; Yoshihisa, Akiomi; Takeishi, Yasuchika; Egstrup, Michael; Gustafsson, Ida; Gaggin, Hanna K.; Eggers, Kai M.; Huber, Kurt; Tentzeris, Ioannis; Ripoli, Andrea; Passino, Claudio; Emdin, Michele.

In: European Journal of Preventive Cardiology, Vol. 26, No. 16, 01.11.2019, p. 1751-1759.

Research output: Contribution to journalArticle

Aimo, A, Januzzi, JL, Vergaro, G, Clerico, A, Latini, R, Meessen, J, Anand, IS, Cohn, JN, Gravning, J, Ueland, T, Nymo, SH, Brunner-La Rocca, HP, Bayes-Genis, A, Lupón, J, de Boer, RA, Yoshihisa, A, Takeishi, Y, Egstrup, M, Gustafsson, I, Gaggin, HK, Eggers, KM, Huber, K, Tentzeris, I, Ripoli, A, Passino, C & Emdin, M 2019, 'Revisiting the obesity paradox in heart failure: Per cent body fat as predictor of biomarkers and outcome', European Journal of Preventive Cardiology, vol. 26, no. 16, pp. 1751-1759. https://doi.org/10.1177/2047487319852809
Aimo, Alberto ; Januzzi, James L. ; Vergaro, Giuseppe ; Clerico, Aldo ; Latini, Roberto ; Meessen, Jennifer ; Anand, Inder S. ; Cohn, Jay N. ; Gravning, Jørgen ; Ueland, Thor ; Nymo, Ståle H. ; Brunner-La Rocca, Hans Peter ; Bayes-Genis, Antoni ; Lupón, Josep ; de Boer, Rudolf A. ; Yoshihisa, Akiomi ; Takeishi, Yasuchika ; Egstrup, Michael ; Gustafsson, Ida ; Gaggin, Hanna K. ; Eggers, Kai M. ; Huber, Kurt ; Tentzeris, Ioannis ; Ripoli, Andrea ; Passino, Claudio ; Emdin, Michele. / Revisiting the obesity paradox in heart failure : Per cent body fat as predictor of biomarkers and outcome. In: European Journal of Preventive Cardiology. 2019 ; Vol. 26, No. 16. pp. 1751-1759.
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abstract = "Aims: Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods: In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson–Pollock and Gallagher equations. Results: Out of 6468 patients (median 68 years, 78{\%} men, 76{\%} ischaemic heart failure, 90{\%} reduced ejection fraction), 24{\%} died over 2.2 years (1.5–2.9), 17{\%} from cardiovascular death. Median PBF was 26.9{\%} (22.4–33.0{\%}) with the Jackson–Pollock equation, and 28.0{\%} (23.8–33.5{\%}) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36{\%} and 27{\%}, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion: In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.",
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TY - JOUR

T1 - Revisiting the obesity paradox in heart failure

T2 - Per cent body fat as predictor of biomarkers and outcome

AU - Aimo, Alberto

AU - Januzzi, James L.

AU - Vergaro, Giuseppe

AU - Clerico, Aldo

AU - Latini, Roberto

AU - Meessen, Jennifer

AU - Anand, Inder S.

AU - Cohn, Jay N.

AU - Gravning, Jørgen

AU - Ueland, Thor

AU - Nymo, Ståle H.

AU - Brunner-La Rocca, Hans Peter

AU - Bayes-Genis, Antoni

AU - Lupón, Josep

AU - de Boer, Rudolf A.

AU - Yoshihisa, Akiomi

AU - Takeishi, Yasuchika

AU - Egstrup, Michael

AU - Gustafsson, Ida

AU - Gaggin, Hanna K.

AU - Eggers, Kai M.

AU - Huber, Kurt

AU - Tentzeris, Ioannis

AU - Ripoli, Andrea

AU - Passino, Claudio

AU - Emdin, Michele

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Aims: Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods: In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson–Pollock and Gallagher equations. Results: Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion: In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

AB - Aims: Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)). Methods: In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson–Pollock and Gallagher equations. Results: Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome. Conclusion: In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

KW - Obesity

KW - heart failure

KW - natriuretic peptides

KW - prognosis

KW - sST2

KW - troponin

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