Evidence map›Paper›PMID 24173404›Full record

SynthesisInternational journal of obesity (2005)2014

The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data.

R Padwal, F A McAlister, J J V McMurray, M R Cowie, M Rich, S Pocock, K Swedberg, A Maggioni, G Gamble, C Ariti and 6 more

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in International journal of obesity (2005), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  13. Association of modifiable risk factors and left ventricular ejection fraction among hospitalized Native Hawaiians and Pacific Islanders with heart failure.Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health · 2014
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41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

R PadwalDepartment of Medicine, University of Alberta, Edmonton, Canada.
F A McAlisterDepartment of Medicine, University of Alberta, Edmonton, Canada.
J J V McMurrayBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
M R CowieFaculty of Medicine, National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK.
M RichWashington University School of Medicine, St Louis, MO, USA.
S PocockDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
K SwedbergDepartment of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
A MaggioniANMCO Research Center, Florence, Italy.
G GambleDepartment of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
C AritiDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
N EarleDepartment of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
G WhalleyFaculty of Social and Health Sciences, UNITEC Institute of Technology, Auckland, New Zealand.
K K PoppeDepartment of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
R N DoughtyDepartment of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
A Bayes-GenisDepartment of Medicine, Hospital Universitari Germans Trias i Pujol UAB, Barcelona, Spain.
Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn heart failure (HF), obesity, defined as body mass index (BMI) ≥30 kg m(-2), is paradoxically associated with higher survival rates compared with normal-weight patients (the 'obesity paradox'). We sought to determine if the obesity paradox differed by HF subtype (reduced ejection fraction (HF-REF) versus preserved ejection fraction (HF-PEF)). PATIENTS AND

methodsA sub-analysis of the MAGGIC meta-analysis of patient-level data from 14 HF studies was performed. Subjects were divided into five BMI groups: <22.5, 22.5-24.9 (referent), 25-29.9, 30-34.9 and ≥35 kg m(-2). Cox proportional hazards models adjusted for age, sex, aetiology (ischaemic or non-ischaemic), hypertension, diabetes and baseline blood pressure, stratified by study, were used to examine the independent association between BMI and 3-year total mortality. Analyses were conducted for the overall group and within HF-REF and HF-PEF groups.

resultsBMI data were available for 23 967 subjects (mean age, 66.8 years; 32% women; 46% NYHA Class II; 50% Class III) and 5609 (23%) died by 3 years. Obese patients were younger, more likely to receive cardiovascular (CV) drug treatment, and had higher comorbidity burdens. Compared with BMI levels between 22.5 and 24.9 kg m(-2), the adjusted relative hazards for 3-year mortality in subjects with HF-REF were: hazard ratios (HR)=1.31 (95% confidence interval=1.15-1.50) for BMI <22.5, 0.85 (0.76-0.96) for BMI 25.0-29.9, 0.64 (0.55-0.74) for BMI 30.0-34.9 and 0.95 (0.78-1.15) for BMI ≥35. Corresponding adjusted HRs for those with HF-PEF were: 1.12 (95% confidence interval=0.80-1.57) for BMI <22.5, 0.74 (0.56-0.97) for BMI 25.0-29.9, 0.64 (0.46-0.88) for BMI 30.0-34.9 and 0.71 (0.49-1.05) for BMI ≥35.

conclusionsIn patients with chronic HF, the obesity paradox was present in both those with reduced and preserved ventricular systolic function. Mortality in both HF subtypes was U-shaped, with a nadir at 30.0-34.9 kg m(-2).

Indexed as

Stroke VolumeAdultBody Mass IndexComorbidityFemaleHeart FailureHumansMaleObesityPrognosisProportional Hazards ModelsRisk FactorsSurvival Analysis

Identifiers

PMID24173404

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.