DALLAS – Bigger is better for patients with heart failure.
Increased weight was associated with a lower risk of death or hospitalization during nearly 5 years of follow-up in a post hoc analysis of more than 2,500 patients with heart failure.
“This is the first time that weight gain has been shown to be related to reduced mortality” in patients with heart failure, Dr. Stefan D. Anker said at the annual scientific sessions of the American Heart Association.
The finding was consistent with previous reports that showed lower survival rates in heart failure patients who had a relatively low body mass index (BMI), said Dr. Anker of the National Heart and Lung Institute in London.
“Obesity is generally good in patients who have heart failure or following a myocardial infarction. Never tell a patient with a BMI of less than 40 kg/m2 to lose weight,” said Dr. Anker. He used a cutoff of 40 kg/m2 because little information is available on larger patients.
The new analysis used data collected in the Carvedilol or Metoprolol European Trial (COMET), which was designed to compare the efficacy of these two ?-blockers in patients with moderate to severe heart failure (Lancet 2003;362:7-13).
The study enrolled patients with New York Heart Association class II-IV disease and a left ventricular ejection fraction of less than 40%. Of the 3,029 patients in the study, Dr. Anker focused his analysis on 86% of patients who did not have edema at baseline. In addition to being treated with one of the two ?-blockers in the study, patients received a full panel of medications for heart failure. They were followed for an average of 58 months.
Mortality among 302 patients whose average BMI was less than 22 during the study was 49%, compared with 32% in 1,145 patients with BMI averages of 25-29.9 and a rate of 25% in 474 patients with averages of 30 or more during the study.
For every increased unit of BMI, mortality fell by 6%, and the rate of death or hospitalization for heart failure dropped by 2%. Both of these rate reductions were statistically significant, Dr. Anker said.
In a multivariate analysis that controlled for many demographic and clinical variables, including treatment group in the COMET study and BMI, every 1% of weight loss during the course of the study was linked with a statistically significant 9% increased risk of death or hospitalization. In addition, every 1% of weight gain during follow-up was linked to a significant 2% reduction in death or hospitalization. The effects of weight loss and gain were independent of each other.
“From whatever BMI a patient starts with, gaining weight is positively associated with better survival and lower hospitalization, and losing weight is negative,” Dr. Anker said.
Treatment with a ?-blocker or with an ACE inhibitor has been linked to weight gain in patients with heart failure. Calorie supplementation may be another way to increase weight and reduce adverse outcomes in heart failure patients, but Dr. Anker said that extra calories might be helpful only if they are in the form of lipids. Future research needs to test the hypothesis that treatments that help heart failure patients gain weight lead to better outcomes.
