Analysis of the influence of Body Mass Index in the evolution of Heart Failure in a Health Area
DOI:
https://doi.org/10.14306/renhyd.24.2.931Keywords:
Obesity, Body Mass Index, Heart Failure, Primary Health CareAbstract
Introduction: To analyze the relationship of the Body Mass Index (BMI) with heart failure in a health area.
Material and methods: Observational descriptive study of the 161 patients who had been diagnosed in the Health Area between January 2014 and December 2016. Demographic, clinical, and analytical data have been analyzed. The BMI is calculated from the weight and height on the first visit to the consultation, using the formula: weight (in kilograms) / square of height (in meters). Once obtained, the relationship between BMI and evolution in 2 years was evaluated. Four subgroups of patients are studied, based on their BMI, based on the criteria defined by the World Health Organization (WHO) in 1999: low weight (BMI < 20.5), normal weight (BMI 20.5 to <25.5), overweight (BMI 25.5 to <30) and obesity (BMI ≥ 30).
Results: Of the participants, 81 were obese (50.8%), being 33 men and 48 women. The average age of the obese is 80.32 (9.23) years. The main causes of heart failure in 62.2% had diagnosed some type of heart disease, being: 29.2% Ischemic heart disease, 46.6% cardiac arrhythmias and 20.5% valvulopathies. BMI as a continuous variable was significantly associated with mortality (p <0.001), age (0.002), ischemic disease (0.001), gender (0.004), hypertension (0.002), diabetes (0.003) and dyslipidemia (0.004). ). The relation of BMI with the use of Digoxin, Asa Diuretics and Spironolactone treatments has also been seen with higher BMI plus utilization. BMI is also associated with the number of admissions, greater number of concomitant chronic diseases and mortality. Obese patients scored higher on the MLWHFQ quality of life questionnaire, which corresponds to a poorer quality of life.
Conclusions: BMI has been shown to be associated with mortality, ischemic disease, sex, hypertension, diabetes and dyslipidemia in patients with heart failure.
References
(1) Rubio MA, Salas J, Barbany M, Moreno B, Aranceta J, Bellido D, et al. Consenso SEEDO 2007 para la evaluación del sobrepeso y la obesidad y el establecimiento de criterios de intervención terapéutica. Rev Esp Obes. 2007; 5: 135-71.
(2) Gustafsson F, Kragelund CB, Torp-Pedersen C, Seibaek M, Burchardt H, Akkan D, et al; DIAMOND study group. et al;and DIAMOND Study Group. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function. Eur Heart J. 2005; 26:58-64.
(3) Javier Aranceta-Bartrinaa, Lluís Serra-Majemb, Màrius Foz-Salac, Basilio Moreno-Esteband, y Grupo Colaborativo SEEDO*. Prevalencia de obesidad en España. Med Clin (Barc). 2005;125(12):460-6.
(4) Trullàs JC, Formiga F, Montero M, Conde A, Casado J, Carrasco FJ, et al. Paradoja de la obesidad en la insuficiencia cardiaca. Resultados del Registro RICA. Med Clin (Barc). 2011;137(15):671-7.
(5) Testa G, Cacciatore F, Galizia G, Della-Morte D, Mazzella F, Langellotto A, et al. Waist circumference but not body mass index predicts long-term mortality in elderly subjects with chronic heart failure. J Am Geriatr Soc. 2010;58: 1433–40.
(6) Curtis LH, Greiner MA, Hammill BG, Kramer JM, Whellan DJ, Schulman KA, et al. Early and long-term outcomes of heart failure in elderly persons, 2001-2005. Arch Intern Med. 2008;168:2481–8.
(7) Davos CH, Doehner W, Rauchhaus M, Cicoira M, Francis DP, Coats AJ, et al. Body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity. J Card Fail. 2003;9:29-35.
(8) Lavie CJ, Osman AF, Milani RV, Mehra MR. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol. 2003;91:891-4.
(9) Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165:55-61.
(10) Lavie CJ, Mehra MR, Milani RV. Obesity and heart failure prognosis: paradox or reverse epidemiology? Eur Heart J. 2005;26:5-7.
(11) Powell BD, Redfield MM, Bybee KA, Freeman WK, Rihal CS. Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Am J Cardiol. 2006; 98:116-20.
(12) Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, Yusuf S. Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. Am Heart J. 2005; 149:54-60.
(13) Tárraga López PJ.,, Villar Inarejos MJ, Sadek IM, Madrona Marcos F., Tárraga Marcos L. Simón García MA.Quality care in the management of heart failure in a health area. Clin Invest Arterios.2018: 258-264.
(14) Roldán Santos P, Tarraga Marcos L, Madrona Marcos F, Sadeh M. I., Celada Roldan C., Panisello Royo JM, Tárraga López PJ. La telemedicina en la insuficiencia cardíaca, el camino pendiente. JONNPR. 2019;4(12):1230-55. DOI: 10.19230/jonnpr.3201
(15) Evangelista LS, Miller PS. Overweight and obesity in the context of heart failure: implications for practice and future research. J Cardiovasc Nurs. 2006; 21:27-33.
(16) Conard MW, Haddock CK, Poston WS, Havranek E, McCullough P, Spertus J. Impact of obesity on the health status of heart failure patients. J Card Fail. 2006; 12:700-6.
(17) Garin O, Soriano N, Ribera A,Ferrer M, Pont A, Alonso J,Permanyer G. Validation of the Spanish Version of the Minnesota Living With Heart Failure Questionnaire. Rev Esp Cardiol. 2008 (61): 251-259.
(18) Vasan RS, Larson MG, Benjamin EJ, Evans JC, Levy D. Left ventricular dilatation and the risk of congestive heart failure in people without myocardial infarction. N Engl J Med 1997; 336:1350-1355
(19) World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.
(20) Gardin JM, McClelland R, Kitzman D, et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol 2001; 87:1051-1057
(21) Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001; 321:225-236
(22) Lind L., Arnlov J., Lampa E. Impact of Aging on the Strength of Cardiovascular Risk Factors: A Longitudinal Study Over 40 Years. JAHA. Vol 1. Nº 1. 2018: e7061.
(23) He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001; 161:996-1002
(24) Wilhelmsen L, Rosengren A, Eriksson H, Lappas G. Heart failure in the general population of men -- morbidity, risk factors, and prognosis. J Intern Med 2001;249:253-261
(25) Guo, X. &Li, Z. E. An update on overweight and obesity in rural Northeast China: from lifestyle risk factors to cardiometabolic comorbidities. BMC Public Health, 2014: 1-9.
(26) Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP. An investigation of coronary heart disease in families: the Framingham Offspring Study. Am J Epidemiol 1979;110:281-290
(27) Obesity: preventing and managing the global epidemic: report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:1-253
(28) Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et-al.. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism..Circulation, 113.2006: 898-918.
(29) Kannel WB, Wolf PA, Garrison RJ, eds. The Framingham Study: an epidemiological investigation of cardiovascular disease. Section 34. Some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements: Framingham Heart Study, 30-year follow-up. Bethesda, Md.: National Heart, Lung, and Blood Institute, 1987. (NIH publication no. 87-2703.)
(30) McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham Study. N Engl J Med 1971;285:1441-1446
(31) Poirier P.. Cardiologists and abdominal obesity: lost in translation?..Heart, 95 (2009:1033-1035.
(32) Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000;101:2118-2121
(33) Nagarajan V, Tang WH. Management of comorbid conditions in heart failure: a review. Med Clin North Am. 2012;96:975-85
(34) Mosterd A, Cost B, Hoes AW, et al. The prognosis of heart failure in the general population: the Rotterdam Study. Eur Heart J 2001;22:1318-1327
(35) Sharma R, Von Haehling S, Rauchhaus M, Bolger AP, Genth-Zotz S, Doehner W, et al. Whole blood endotoxin responsiveness in patients with chronic heart failure: the importance of serum lipoproteins. Eur J Heart Fail. 2005;7:479–84
(36) López-Jiménez Fa,, Cortés-Bergoder M. Obesity and the Heart.Rev. Esp Cardiol.Vol. 64. Feb 2011(2): 140-149.
(37) Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. Am Heart J. 2010; 159:75–80.
(38) Pérez-Calvo JI, Montero-Pérez-Barquero M, Camafort-Babkowski M, ContheGutiérrez P, Formiga F, Aramburu-Bodas O, et al. Influence of admission blood pressure on mortality in patients with acute decompensated heart failure. QJM. 2010;104:325–33.
(39) Body Mass Index. Nutrition and food security. World Health Organization Regional Office for Europe [consultado 7 Feb 2020]. Disponible en: www.euro. who.int/nutrition.
(40) Zamora E, Lupón J, Urrutia A, González B, Mas D, Pascual T, et al. ¿El índice de masa corporal influye en la moralidad de los pacientes con insuficiencia cardiaca? Rev Esp Cardiol. 2007;60:1127–3440.
(41) Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, et al. Influence of etiology of heart failure on the obesity paradox. Am J Cardiol.2009;104:1116–21
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