title: Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program.
abstract: BACKGROUND
  In individuals without known cardiovascular disease, elevated body mass index (BMI) (weight/height2) is associated with an increased risk of death. However, in patients with certain specific chronic diseases, including heart failure, low BMI has been associated with increased mortality.
  
  
  RESULTS
  We examined the influence of BMI on prognosis using Cox proportional hazards models in 7599 patients (mean age, 65 years; 35% women) with symptomatic heart failure (New York Heart Association class II to IV) and a broad spectrum of left ventricular ejection fractions (mean, 39%) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. During a median follow-up of 37.7 months, 1831 patients died. After adjustment for potential confounders, compared with patients with BMI between 30 and 34.9, patients in lower BMI categories had a graded increase in the risk of death. The hazard ratios (95% confidence intervals) were 1.22 (1.06 to 1.41), 1.46 (1.24 to 1.71), and 1.69 (1.43 to 2.01) among those with BMI of 25 to 29.9, 22.5 to 24.9, and < 22.5, respectively. The increase in risk of death among patients with BMI > or = 35 was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43). The association between BMI and mortality was not altered by age, smoking status, or left ventricular ejection fraction (P for interaction >0.20). However, lower BMI was associated with a greater risk of all-cause death in patients without edema but not in patients with edema (P for interaction <0.0001). Lower BMI was associated with a greater risk of cardiovascular death and noncardiovascular death. Baseline BMI did not influence the risk of hospitalization for worsening heart failure or due to all causes.
  
  
  CONCLUSIONS
  In patients with symptomatic heart failure and either reduced or preserved left ventricular systolic function, underweight or low BMI was associated with increased mortality, primarily in patients without evidence of fluid overload (edema).
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. skenchaiah@rics.bwh.harvard.edu
authors.forename: Satish
authors.initials: S
authors.lastname: Kenchaiah
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: Peter V
authors.initials: PV
authors.lastname: Finn
authors.forename: Leonardo A M
authors.initials: LA
authors.lastname: Zornoff
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Eric L
authors.initials: EL
authors.lastname: Michelson
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D015992:Body Mass Index; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan