부산대학교 도서관

Introduction: The obesity paradox, as observed in those with heart failure and a reduced ejection fraction (HFrEF), suggests that a higher body mass index values (≥25 kg/m) is associated with an improved survival. It is unknown if healthy weight change in those with HFrEF affects survival. Data from the HF-ACTION trial provides a unique opportunity to assess the association between change in weight and outcome risk in patients with HFrEF.Hypothesis: Weight change will be associated with outcome.Methods: The HF-ACTION study randomized patients with HFrEF to 36 sessions of cardiac rehabilitation or usual care. Body weight was determined at baseline (BL) and 3 mo. We excluded patients with missing weight data or who were hospitalized or died prior to 3 mo. Weight change was assessed as both a continuous and 3 categories (i.e., > 3 kg gain, > 3 kg loss, or -3 to +3 kg change) variable. Cox proportional hazards regression analysis was used to evaluate the impact of weight change on a composite outcome of all-cause mortality or hospitalization.Results: 1,242 subjects (mean age: 59±12 y; BMI 31±7 kg/m; 28% female) met the inclusion criteria, including complete covariate data. Follow-up was over 1.8+1.1 y. In unadjusted analysis, neither weight change as a continuous (HR=0.99; 95% CI, 0.94-1.04) or categorical (HR=1.08; 95% CI, 0.82-1.43) variable was significantly associated with the endpoint. Analyses with adjustment for 14 clinical co-variates (including randomization assignment) were also not significant (HR=0.99; 95% CI, 0.94-1.04; HR=1.08; 95% CI, 0.82-1.43) for continuous and categorical weight, respectively.Conclusions: In this cohort of patients with HFrEF, weight change during a supervised exercise program was not associated with time to the composite outcome of all-cause mortality and hospitalization. This data suggests that a weight change of 3 kg or greater (gain or loss) over 3 mo does not affect outcome up to 1.8 y. For those with HFrEF and weight-loss responsive comorbidities, weight loss through exercise and cardiac rehabilitation can be encouraged without concern for elevating mortality and hospitalization risk.