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Clinical Summary

Higher waist-to-hip ratio tied to increased mortality risk in heart failure patients

Takeaway           

  • Higher waist-hip ratio (WHR) is associated with increased risk for mortality in female but not in male patients with heart failure (HF).
  • This association may be explained by higher inflammatory status and is independent of BMI.

Why this matters

  • Abdominal fat is better estimated by measuring WHR however; association between WHR and clinical outcome in patients with established HF is unknown.
  • Findings challenge the obesity paradox and suggest the pathophysiological harmful effect of abdominal fat deposition, which may be a target for therapy in patients with HF.

Method:

  • Retrospective study of 1479 patients (men, n=997; women, n=482) with high BMI from the Scottish BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) validation study.
  • Funding: The Netherlands Cardiovascular Research Initiative.

Study results

  • Mean WHR was 0.93±0.09 in women and 1.00±0.08 in men.
  • In both women and men, a higher WHR was associated with higher body weight (P=.003 and P<.001), higher glucose levels (P=.004 and P=.001) and lower serum iron levels (P=.021 and P=.020).
  • Significant interaction was seen between sex and WHR on the risk of death (Pinteraction<.001).
  • In women with high WHR, risk for mortality was significantly high (HR, 2.23; 95% CI, 1.37-3.63; P=.001) vs men with high WHR (HR, 0.87; 95% 0.63-1.20; P=.409).

Limitation:

  • Retrospective design.
  • Difficult to differentiate between fat and fluid in patients with HF and a large abdominal mass.

References


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