Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure

Carl J. Lavie, Lawrence P Cahalin, Paul Chase, Jonathan Myers, Daniel Bensimhon, Mary Ann Peberdy, Euan Ashley, Erin West, Daniel E. Forman, Marco Guazzi, Ross Arena

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF). Patients and Methods: We studied 2066 patients with systolic HF (body mass index [BMI] gt;18.5 kg/m2) between April 1, 1993 and May 11, 2011 (with 1784 [86%] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption <14 vs gt;14 mL O2 . kg-1 . min-1) on the obesity paradox. Results: There were 212 deaths during follow-up (annual mortality, 4.5%). In patients with low FIT, annual mortality was 8.2% compared with 2.8% in those with high FIT (P<.001). After adjusting for age and sex, BMI was a significant predictor of survival in the low FIT subgroup when expressed as a continuous (P=.03) and dichotomous (<25.0 vs gt;25.0 kg/m2) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42). Conclusion: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.

Original languageEnglish
Pages (from-to)251-258
Number of pages8
JournalMayo Clinic Proceedings
Volume88
Issue number3
DOIs
StatePublished - Jan 1 2013

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Systolic Heart Failure
Body Mass Index
Heart Failure
Obesity
Survival
Mortality
Oxygen Consumption
Cardiorespiratory Fitness
Databases
Exercise

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure. / Lavie, Carl J.; Cahalin, Lawrence P; Chase, Paul; Myers, Jonathan; Bensimhon, Daniel; Peberdy, Mary Ann; Ashley, Euan; West, Erin; Forman, Daniel E.; Guazzi, Marco; Arena, Ross.

In: Mayo Clinic Proceedings, Vol. 88, No. 3, 01.01.2013, p. 251-258.

Research output: Contribution to journalArticle

Lavie, CJ, Cahalin, LP, Chase, P, Myers, J, Bensimhon, D, Peberdy, MA, Ashley, E, West, E, Forman, DE, Guazzi, M & Arena, R 2013, 'Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure', Mayo Clinic Proceedings, vol. 88, no. 3, pp. 251-258. https://doi.org/10.1016/j.mayocp.2012.11.020
Lavie, Carl J. ; Cahalin, Lawrence P ; Chase, Paul ; Myers, Jonathan ; Bensimhon, Daniel ; Peberdy, Mary Ann ; Ashley, Euan ; West, Erin ; Forman, Daniel E. ; Guazzi, Marco ; Arena, Ross. / Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure. In: Mayo Clinic Proceedings. 2013 ; Vol. 88, No. 3. pp. 251-258.
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abstract = "Objective: To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF). Patients and Methods: We studied 2066 patients with systolic HF (body mass index [BMI] gt;18.5 kg/m2) between April 1, 1993 and May 11, 2011 (with 1784 [86{\%}] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption <14 vs gt;14 mL O2 . kg-1 . min-1) on the obesity paradox. Results: There were 212 deaths during follow-up (annual mortality, 4.5{\%}). In patients with low FIT, annual mortality was 8.2{\%} compared with 2.8{\%} in those with high FIT (P<.001). After adjusting for age and sex, BMI was a significant predictor of survival in the low FIT subgroup when expressed as a continuous (P=.03) and dichotomous (<25.0 vs gt;25.0 kg/m2) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42). Conclusion: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.",
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AU - Cahalin, Lawrence P

AU - Chase, Paul

AU - Myers, Jonathan

AU - Bensimhon, Daniel

AU - Peberdy, Mary Ann

AU - Ashley, Euan

AU - West, Erin

AU - Forman, Daniel E.

AU - Guazzi, Marco

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AB - Objective: To determine the impact of cardiorespiratory fitness (FIT) on survival in relation to the obesity paradox in patients with systolic heart failure (HF). Patients and Methods: We studied 2066 patients with systolic HF (body mass index [BMI] gt;18.5 kg/m2) between April 1, 1993 and May 11, 2011 (with 1784 [86%] tested after January 31, 2000) from a multicenter cardiopulmonary exercise testing database who were followed for up to 5 years (mean ± SD, 25.0±17.5 months) to determine the impact of FIT (peak oxygen consumption <14 vs gt;14 mL O2 . kg-1 . min-1) on the obesity paradox. Results: There were 212 deaths during follow-up (annual mortality, 4.5%). In patients with low FIT, annual mortality was 8.2% compared with 2.8% in those with high FIT (P<.001). After adjusting for age and sex, BMI was a significant predictor of survival in the low FIT subgroup when expressed as a continuous (P=.03) and dichotomous (<25.0 vs gt;25.0 kg/m2) (P=.01) variable. Continuous and dichotomous BMI expressions were not significant predictors of survival in the overall and high FIT groups after adjusting for age and sex. In patients with low FIT, progressively worse survival was noted with BMI of 30.0 or greater, 25.0 to 29.9, and 18.5 to 24.9 (log-rank, 11.7; P=.003), whereas there was no obesity paradox noted in those with high FIT (log-rank, 1.72; P=.42). Conclusion: These results indicate that FIT modifies the relationship between BMI and survival. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered.

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