Original articleExercise Capacity and the Obesity Paradox in Heart Failure: The FIT (Henry Ford Exercise Testing) Project
Section snippets
Patients and Methods
The FIT Project includes 69,885 patients who completed a physician-referred treadmill exercise test at Henry Ford Hospital and affiliated medical centers in metropolitan Detroit, Michigan, from January 1, 1991, through May 31, 2009. Additional information on participant characteristics and methods has been published elsewhere.15 Patients in the present study were drawn from a sample of 42,854 FIT Project participants who had complete information on BMI and METs achieved on a treadmill exercise
Results
During a mean follow-up of 10.1±4.6 years, 380 patients (49%) died. The baseline characteristics of the study cohort both overall and by EC category are summarized in Table 1. (Descriptive statistics for the full cohort of 1212 patients with HF are provided in Supplemental Table 1, available online at http://www.mayoclinicproceedings.org.) Overall, 326 (42%) patients were obese (BMI≥30.0 kg/m2). Patients with lower EC were older (P<.001) and were more likely to be female (P<.001) and black (P
Discussion
In this biracial sample of patients with HF, an obesity paradox was observed only in those with lower EC, as previously reported in studies with shorter follow-up periods of 2 to 3 years.11, 12, 13 The present study was the first to report this in a large sample with longer follow-up (>10 years), upholding the presence of an obesity paradox in patients with HF and low EC. Although we did not observe a significant interaction between BMI and EC in the overall study population (P=.97), EC
Conclusion
We found that higher BMI was associated with lower 10-year mortality in patients with HF and lower EC, but not higher EC. Our findings underscore the importance of stratifying patients with HF by EC. Future studies should investigate whether maintaining or gaining weight is advantageous to nonobese patients with HF who have a lower EC.
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Cited by (41)
The Impact of Obesity in Heart Failure
2022, Cardiology ClinicsCitation Excerpt :Similarly, in a recent analysis of 774 patients with HFrEF and HFpEF followed for up to 12 years, those with preserved CRF, defined as having an estimated METs of 4 or more, presented with a similar prognosis independent of BMI. In contrast, in those with a lower CRF (<4 METs), an obesity paradox was reported.29 Taken together, these results suggest that the obesity paradox is highly relevant in those individuals with reduced CRF, proposing the addition of measured or estimated CRF for a more accurate risk stratification in patients with HF.
Frailty Measures of Patient-reported Activity and Fatigue May Predict 1-year Outcomes in Ambulatory Advanced Heart Failure: A Report From the REVIVAL Registry
2022, Journal of Cardiac FailureCitation Excerpt :We also identified a low prevalence of weight loss (approximately 1% of patients) similar to that reported by Reeves et al, but disparate from the 38% reported by Vidan et al,29 likely owing to the advanced age of their cohort compared with the current analysis. In fact, in the REVIVAL population body-mass index was actually higher with increasing degree of frailty.27,28 Assessment of weight changes in HF is challenging owing to fluctuations in volume status, where loss of muscle mass may be masked by hypervolemia, again suggesting that weight loss may not be a critical component of the frailty assessment in patients living with HF. 12,24,25
Pooled Cohort Equations and the competing risk of cardiovascular disease versus cancer: Multi-Ethnic study of atherosclerosis
2021, American Journal of Preventive CardiologyBody Mass Index and 90-Day Mortality Among 35,406 Danish Patients Hospitalized for Infection
2021, Mayo Clinic ProceedingsCitation Excerpt :This pattern was robust after controlling for potential confounding factors, and the greater impact of underweight compared with obesity on mortality was consistent for major subtypes of infections. Our findings corroborate and extend the few previous findings and support the hypothesis of a protective effect of overweight/obesity against death from severe infections.12-16 The mechanisms are not clear, but evolutionarily, a possible survival benefit among individuals with obesity may be related to proinflammatory defenses and large energy reserves, protecting against death from infections such as sepsis when starvation and infection were common and life span was short.34,35
Implications of obesity across the heart failure continuum
2020, Progress in Cardiovascular DiseasesCitation Excerpt :For example, Lavie et al.51 evaluated 2066 patients with systolic HF and found that BMI was a significant predictor of improved survival in the low fitness group defined as peak Vo2 < 14, but not in the high CRF group. More recently, a study from the Henry Ford Exercise Training Project found no relationship between BMI and mortality in the subgroup with exercise tolerance at or above 4 METs, while the obesity paradox was observed in the low exercise capacity group.52 These studies suggest that in the unfit population, obese HF patients have better outcomes, whereas this benefit is lost when compared to groups with preserved fitness.
Potential Competing Interests: The authors report no competing interests.