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Waist-to-hip ratio and mortality in heart failure.

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journal contribution
posted on 16.08.2018, 09:07 by Koen W. Streng, Adriaan A. Voors, Hans L. Hillege, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Marco Metra, Leong L Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Aeilko H. Zwinderman, Faiez Zannad, Kevin Damman, Peter van der Meer, Chim C. Lang
AIMS: A higher body mass index (BMI) is associated with better survival in heart failure (HF) patients, also known as the obesity paradox. However, BMI does not account for body composition. We therefore analysed the association between abdominal fat, measured via waist-to-hip ratio (WHR), BMI and all-cause mortality in patients with HF. METHODS AND RESULTS: For this analysis, 1738 patients from the Scottish BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) validation study were included. Patients without waist and hip measurements were excluded. WHR was defined as waist circumference/hip circumference, divided into tertiles and split for sex. A linear regression of principal components from an extensive panel of biomarkers was performed to provide insight in the pathophysiology behind a higher WHR. In total, 1479 patients were included, of which 33% were female and mean age was 75 ±11 years. A higher WHR was independently associated with a higher BMI, a higher prevalence of diabetes and higher New York Heart Association functional class. There was a significant interaction between sex and WHR on its association with mortality (P <0.001). In women, a higher WHR was associated with a higher mortality risk [hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.37-3.63; P =0.001], whereas no significant association was found in men (HR 0.87, 95% CI 0.63-1.20; P = 0.409). We found a strong association between a higher WHR and elevated markers of inflammation and MAPK cascade in women, while these associations were less profound in men. CONCLUSIONS: A higher WHR was associated with a higher risk of death in female but not in male HF patients. These findings challenge the obesity paradox, and suggest that fat deposition is pathophysiologically harmful and may be a target for therapy in female patients with HF.


This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation [CVON2014-11 RECONNECT] and a grant from the European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29].



European Journal of Heart Failure, 2018

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences


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European Journal of Heart Failure


Wiley for European Society of Cardiology





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The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.;Additional supporting information may be found online in theSupporting Information section at the end of the article.Ta b l e S 1. Olink biomarkers and domains.Ta b l e S 2 . Hazard ratio for tertiles of waist-to-hip ratio in differentheart failure subgroups and all-cause mortality.Figure S1. Histogram of distribution of waist-to-hip ratio in thetotal population, in women and men.Figure S2. Hazard ratio for waist-to-hip ratio separated forwomen and men in HFrEF, HFmrEF and HFpEF. Corrected for age,urea, NT-proBNP, haemoglobin, use of beta-blocker and statins.Figure S3. Hazard ratio for waist and hip circumference in womenand men.