Associations of BMI with mortality in HFpEF patients with concomitant diabetes with insulin versus non-insulin treatment.

Obesity confers paradoxical survival benefits in heart failure with preserved ejection fraction (HFpEF). The purpose of this study was to examine the impact of DM and insulin treatment status on the associations of body mass index (BMI) with the death risks in HFpEF patients. HFpEF patients from the TOPCAT trial were included. Cox regression model was constructed to assess the relationship of BMI with the risks of all-cause death and cardiovascular death. Restricted cubic splines were used to characterize the dose-response associations of BMI with risks of death. Compared with normal weight, hazard ratios of all-cause death in overweight and class I obesity were 0.62 (0.45-0.85), 0.67 (0.47-0.94) in no DM HFpEF patients, and 0.48 (0.25-0.91), 0.41 (0.22-0.79) in non-insulin-treated DM patients. However, insulin treatment removed this beneficial effect. Consistent results were found when modeling for time-updated BMI. Cubic spline analyses suggested a linear trend of increased death risk with higher BMI in insulin-treated DM patients. The "obesity paradox" was present in HFpEF patients without DM or with non-insulin-treated DM but absent in those with insulin-treated DM. Insulin treatment may be a crucial confounder of the obesity paradox in HFpEF patients. URL: https://clinicaltrials.gov. Unique identifier: NCT00094302. Copyright © 2022 Elsevier B.V. All rights reserved.

Citation

Min Ye, Manting Choy, Xiao Liu, Peisen Huang, Yuzhong Wu, Yugang Dong, Wengen Zhu, Chen Liu. Associations of BMI with mortality in HFpEF patients with concomitant diabetes with insulin versus non-insulin treatment. Diabetes research and clinical practice. 2022 Mar;185:109805

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PMID: 35219761

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