Association of obesity with heart failure outcomes in 11 Asian regions: A cohort study

• DOI: 10.1371/journal.pmed.1002916
• Publication Date: 2019-09-24T17:22:25Z
• Authors: Chanchal Chandram...; Wan Ting Tay; Nurul Sahiddah Ba...; Jasper Tromp; Tiew-Hwa Katherin...; Jonathan J. L. Yap; Michael R. MacDonald; Chung-Lieh Hung; Koen Streng; Ajay Naik; Gurpreet Singh Wa...; Jitendra Sawhney; Lieng Hsi Ling; A. Mark Richards; Inder Anand; Adriaan A. Voors; Carolyn S. P. Lam
• Keywords: Male; Asia; Risk Assessment; Body Mass Index; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Humans; Ventricular Function; Obesity; Prospective Studies; Registries; METAANALYSIS; Adiposity; Aged; RISK; Heart Failure; 2. Zero hunger; Waist-Hip Ratio; MORTALITY; R; 1. No poverty; Stroke Volume; Middle Aged; 3. Good health; BODY-MASS INDEX; FAT; PARADOX; Medicine; ADIPOSITY; Female; SUDDEN CARDIAC DEATH; Research Article

Asians are predisposed to a lean heart failure (HF) phenotype. Data on the 'obesity paradox', reported in Western populations, scarce Asia and have only utilised traditional classification of body mass index (BMI). We aimed investigate association between obesity (defined by BMI abdominal measures) HF outcomes Asia.Utilising Asian Sudden Cardiac Death Heart Failure (ASIAN-HF) registry (11 regions including Taiwan, Hong Kong, China, India, Malaysia, Thailand, Singapore, Indonesia, Philippines, Japan, Korea; 46 centres with enrolment 1 October 2012 6 2016), we prospectively examined 5,964 patients symptomatic (mean age 61.3 ± 13.3 years, 26% women, mean 25.3 5.3 kg/m2, 16% preserved ejection fraction [HFpEF; ≥ 50%]), among whom 2,051 also had waist-to-height ratio (WHtR) measurements 60.8 12.9 24% 25.0 5.2 7% HFpEF). Patients were categorised quartiles or WHtR 4 combined groups (low, <24.5 kg/m2 [lean], high, ≥24.5 [obese]) <0.55 [thin], ≥0.55 [fat]). Cox proportional hazards models used examine 1-year composite outcome (HF hospitalisation mortality). Across quartiles, higher was associated lower risk (ptrend < 0.001). Contrastingly, outcome. Individuals lean-fat group, low high (13.9%), more likely be women (35.4%) from low-income countries (47.7%) (predominantly South/Southeast Asia), prevalence diabetes (46%), worse quality life scores (63.3 24.2), rate (51/232; 22%), compared other (p 0.05 for all). Following multivariable adjustment, group adjusted (hazard 1.93, 95% CI 1.17-3.18, p = 0.01), obese-thin WHtR. Results consistent across both subtypes (HFpEF reduced [HFrEF]; pinteraction 0.355). Selection bias residual confounding potential limitations such multinational observational registries.In this cohort HF, paradox' is observed when defined using BMI, showing opposite Lean-fat patients, worst outcomes. A direct correlation apparent HFpEF HFrEF.Asian Registry ClinicalTrials.gov Identifier: NCT01633398.