title: Body mass index, prognosis and mode of death in chronic heart failure: results from the Valsartan Heart Failure Trial.
abstract: OBJECTIVE
  To assess the relationship between body mass index (BMI), mortality and mode of death in chronic heart failure (CHF) patients; to define the shape of the relationship between BMI and mortality.
  
  
  RESULTS
  We performed a post-hoc analysis of 5010 patients from the Valsartan Heart Failure Trial. The end-points of the study were all-cause and cardiovascular mortality. Mortality rate was 27.2% in underweight patients (BMI<22 kg/m2), 21.7% in normal weight patients (BMI 22-24.9 kg/m2), 17.9% in overweight patients (BMI 25-29.9 kg/m2) and 16.5% in obese patients (BMI>30 kg/m2) (p<0.0001). The rates of non-cardiovascular death did not differ among groups. The risk of death due to progressive heart failure was 3.4-fold higher in the underweight than in the obese patients (p<0.0001). Normal weight, overweight and obese patients had lower risk of death as compared with underweight patients (p=0.019, HR 0.76, 95% CI 0.61-0.96; p=0.0005, HR 0.68, 95% CI 0.55-0.84; p=0.003, HR 0.67, 95% CI 0.52-0.88, respectively) independently of symptoms, ventricular function, beta-blocker use, C-reactive protein and brain natriuretic peptide levels.
  
  
  CONCLUSIONS
  In CHF patients a higher BMI is associated with a better prognosis independently of other clinical variables. The relationship between mortality and BMI is monotonically decreasing.
authors.affiliation: Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Piazzale Stefani, 1-Verona, Italy, and Hospital General Universitari Vall D'Hebron, Department of Cardiology, Barcelona, Spain. centro_studi@anmco.it
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Elisa
authors.initials: E
authors.lastname: Carretta
authors.forename: Andras
authors.initials: A
authors.lastname: Janosi
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler Soler
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.forename: Jay N
authors.initials: JN
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity; D050177:Overweight; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013534:Survival