DOC News October 1, 2007
Volume 4 Number 10 p. 15
© 2007 American Diabetes Association
Heart Failure Mortality Rises With Low BMI
It may seem counterintuitive, but people with symptomatic chronic heart
failure who are underweight or have a low body mass index (BMI) have a greater
risk of death than heavier patients, according to a recently published
report.
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IMAGE SOURCE/JUPITER IMAGES
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A group of investigators examined the influence of BMI on the prognosis of
7,599 people with symptomatic heart failure and varying degrees of left
ventricular ejection fraction. During an average follow-up of 37.7 months,
1,831 participants died.
Analysis revealed a graded increase in the risk of death at the lower end
of BMI, ranging from 22% higher for BMIs of 25–29.9 to nearly 70% higher
for BMIs <22.5. The risk of death was also highest in low BMI and
underweight patients who showed no fluid overload.
The authors conclude that there's an association between mortality and low
BMI in patients with symptomatic heart failure and either reduced or preserved
left ventricular systolic function.
Speculating on possible reasons for this association, the authors note,
"Lower BMI in patients with [heart failure]... may have been due to
preceding involuntary weight loss or cardiac cachexia, a heightened metabolic
or increased catabolic state associated with worse prognosis. By the same
token, higher BMI, except when produced by edema, might indicate a greater
metabolic reserve, increased tolerance to metabolic stress, and/or a less
severe form of [heart failure]."
Kenchaiah S, Popcock SJ, Wang D, et al.: Body mass index
and prognosis in patients with chronic heart failure.
Circulation 116:627–636, 2007.[Abstract/Free Full Text]
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