title: Obesity Paradox: Comparison of Heart Failure Patients With and Without Comorbid Diabetes.
abstract: BACKGROUND
  Diabetes is a common comorbid condition in patients with heart failure and is strongly associated with poor outcomes. Patients with heart failure who have diabetes are more likely to be obese than are those without diabetes. Obesity is positively associated with survival in patients with heart failure, but how comorbid diabetes influences the relationship between obesity and favorable prognosis is unclear.
  
  
  OBJECTIVE
  To explore whether the relationship between body mass index and survival differs between patients with heart failure who do or do not have diabetes.
  
  
  METHODS
  The sample consisted of 560 ambulatory patients with heart failure (mean age, 66 years; mean body mass index, 32; diabetes, 41%). The association between body mass index and all-cause mortality was examined by using multivariate Cox proportional hazards regression after adjustments for covariates.
  
  
  RESULTS
  In patients without diabetes, higher body mass index was associated with a lower risk for all-cause mortality after adjustments for covariates (hazard ratio, 0.952; 95% CI, 0.909-0.998). In patients with diabetes, body mass index was not predictive of all-cause death after adjustments for covariates.
  
  
  CONCLUSIONS
  Obesity was a survival benefit in heart failure patients without comorbid diabetes but not in those with comorbid diabetes. The mechanisms underlying the difference in the relationship between obesity and survival due to the presence of diabetes in patients with heart failure need to be elucidated.
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California. kslee14@cnu.ac.kr.
authors.forename: Kyoung Suk
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Pelter
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nesbitt
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Southard
authors.affiliation: Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology