Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox

PURPOSE: Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS: We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS: We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355−0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450−1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696−1.319) in women. CONCLUSION: In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.

Epidemiologia, fisiopatologia e prognóstico da insuficiência cardíaca com fração de ejeção preservada / Epidemiology, pathophysiology, and prognosis of heart failure with preserved ejection fraction

A insuficiência cardíaca com fração de ejeção preservada (ICFEP) ainda apresentam alguns problemas na definição e no entedimento da fisiopatologia, o que afeta as pesquisas para a descoberta de tratamento eficaz. Independentemente de qual critério diagnóstico utilizado, a prevalência da ICFEP aumentou nos últimos anos. Aparentemente, mais de 50% dos casos de insuficiência cardíaca (IC) são por ICFEP. Até o momento, não existem estudos que avaliaram especificamente a incidência da ICFEP na comunidade. No Brasil, o cenário da ICFEP é ainda mais nebuloso. A maioria dos indivíduos com ICFEP apresenta múltiplas comorbidades que podem ser causa ou contribuírem para o fenótipo da doença, incluíndo hipertensão arterial, diabetes mellitus, doença arterial coronária, doença renals crônica, anemia e obesidade. A função distólica é definida como a habilidade do venrículo encher e depende do relaxamento miocárdico ativo (necessita de energia) e das propriedades passivas (rigidez). Os processos cardiovasculares que podem contribuir para a disfuncão diastólica são aqueles que influenciam o funcionamento ao nível do sarcômero, da matriz extracelular ao redor do miócito da câmara cardíaca (incluindo hipertrofia ventricular esquerda e remodelamento concêntrico). Em relação ao prognóstico, alguns estudos epidemiológicos e de registro relataram resultados clínicos similares para pacientes com ICFEP e IC sistólica, enquanto outros mostraram declínio da mortalidade ao longo dos anos para a ICFEP e IC sistólica, enquanto outros mostraram declínio da mortalidade ao longo dos anos para a ICFEP.

Heart failure with preserved ejection fraction (HFPEF) shows some problems in its definition as well as understanding the pathophysiology which affects the research for an effective treatment. Regardless of diagnostic criteria used the prevalence of HFPEF having increased in recent years. Apparently more than 50% of cases of heart failure (HF) are by HFPEF. So far there are no studies that specifically eveluated the incidence of HFpEF in the general population. In Brazil, the scene of HFpEF is even more nebulous. Most individuals with HFPEF present multiple co-morbidities that may cause or contribute to the phenotype of the disease, including hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, anemia, and obesity. Diastolic function is defined as the ability of ventricular filling that depends on the active myocardial relaxation (energy needs) and passive properties (stiffness). Cardiovascular process that contribute to the diastolic dysfunction are those which operating at level of the sarcomere, extracellular matrix around the myocytes and cardiac chamber (including left ventricular hyperthropy and concentric remodeling). Regarding prognosis, epidemiological studies and registries reported similar clinical outcomes for patients with systolic HF and HFPEF, white other studies showed decline in mortality over the years with HFPEF.