title: Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial.
abstract: BACKGROUND
  Obesity is a major risk factor for incident heart failure (HF). Paradoxically, in HF with reduced left ventricular ejection fraction (HFREF), a high body mass index (BMI) appears to be beneficial. Approximately 50% of HF patients have a preserved left ventricular ejection fraction (HFPEF). However, there are few data regarding the relationship between BMI and outcomes in HFPEF.
  
  
  RESULTS
  Baseline characteristics and cardiovascular outcomes were assessed in the 4109 patients (mean age, 72 years; mean follow-up, 49.5 months) in the Irbesartan in HF with Preserved Ejection Fraction (I-PRESERVE) trial. Based on the BMI distribution, 5 BMI categories were defined: <23.5, 23.5 to 26.4, 26.5 to 30.9, 31 to 34.9, and ≥35 kg/m(2). Most patients (71%) had a BMI ≥26.5, 21% had a BMI between 23.5 and 26.4, and 8% had a BMI <23.5 kg/m(2). Patients with higher BMI were younger, more often women, and more likely to have hypertension and diabetes and higher left ventricular ejection fraction. Patients with BMI of 26.5 to 30.9 kg/m(2) had the lowest rate for the primary composite outcome (death or cardiovascular hospitalization) and were used as reference group. After adjustment for 21 risk variables including age, sex, and N-terminal pro-brain natriuretic peptide, the hazard ratio for the primary outcome was increased in patients with BMI <23.5 (hazard ratio, 1.27; 95% confidence interval, 1.04 to 1.56; P=0.019) and in those with BMI ≥35 kg/m(2) (hazard ratio, 1.27; 95% confidence interval, 1.06 to 1.52; P=0.011) compared with the referent group. A similar relationship was found for all-cause mortality and for HF hospitalization.
  
  
  CONCLUSIONS
  Obesity is common in HFPEF patients and is accompanied by multiple differences in clinical characteristics. Independent of other key prognostic variables, there was a U-shaped relationship, with the greatest rate of adverse outcomes in the lowest and highest BMI categories.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT000095238.
authors.affiliation: Department of Cardiology, Theresienkrankenhaus, Mannheim, Germany. m.haass@theresienkrankenhaus.de
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Alan
authors.initials: A
authors.lastname: Miller
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan