The health outcomes of inflammation and obesity in patients with heart failure

Zyad T. Saleh; Terry A. Lennie; Muhammad Darawad; Hamza Alduraidi; Rami A. Elshatarat; Issa M. Almansour; Debra K. Moser

doi:10.1016/j.hrtlng.2020.05.010

The health outcomes of inflammation and obesity in patients with heart failure

Zyad T. Saleh
, Terry A. Lennie
, Muhammad Darawad
, Hamza Alduraidi
, Rami A. Elshatarat
, Issa M. Almansour
, Debra K. Moser

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. Hypothesis: Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. Method: A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. Results: There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01–2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. Conclusion: Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.

Original language	English
Pages (from-to)	896-901
Number of pages	6
Journal	Heart and Lung
Volume	49
Issue number	6
DOIs	https://doi.org/10.1016/j.hrtlng.2020.05.010
State	Published - Nov 1 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Inc.

Funding

This work was supported by National Institute of Nursing Research NIH RO1NR009280, National Institute of Nursing Research NIH P20NR0106791, American Heart Association, Great Rivers Affiliate Postdoctoral Fellowship, National Center for Research Resources, NIH UL1 RR025008, National Center for Advancing Translational Sciences, NIH UL1TR000117, General Clinical Research Centers NIH: Indiana University M01RR000750, Atlanta Veterans Administration Medical Center, and Clarian Health Partners (Indiana).

Funders	Funder number
American the American Heart Association
Clarian Health Partners
AHA Great Rivers Affiliate
Atlanta Veterans Administration Medical Center
National Center for Research Resources
National Institutes of Health (NIH)	UL1 RR025008
National Institutes of Health (NIH)
National Center for Advancing Translational Sciences (NCATS)	UL1TR000117
National Center for Advancing Translational Sciences (NCATS)
University of Southern Indiana	M01RR000750
University of Southern Indiana
National Institute of Health National Institute of Nursing Research	P20NR0106791, RO1NR009280
National Institute of Health National Institute of Nursing Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Health outcome
Heart failure
Inflammation
Obesity

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.hrtlng.2020.05.010

Cite this

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title = "The health outcomes of inflammation and obesity in patients with heart failure",

abstract = "Background: Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. Hypothesis: Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. Method: A sample of 415 patients with HF (age 61 ± 11.5 years; 31\% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. Results: There were 177 patients (43\%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95\% confidence interval = 1.01{\textendash}2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. Conclusion: Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.",

keywords = "Health outcome, Heart failure, Inflammation, Obesity",

author = "Saleh, \{Zyad T.\} and Lennie, \{Terry A.\} and Muhammad Darawad and Hamza Alduraidi and Elshatarat, \{Rami A.\} and Almansour, \{Issa M.\} and Moser, \{Debra K.\}",

note = "Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = nov,

day = "1",

doi = "10.1016/j.hrtlng.2020.05.010",

language = "English",

volume = "49",

pages = "896--901",

number = "6",

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T1 - The health outcomes of inflammation and obesity in patients with heart failure

AU - Saleh, Zyad T.

AU - Lennie, Terry A.

AU - Darawad, Muhammad

AU - Alduraidi, Hamza

AU - Elshatarat, Rami A.

AU - Almansour, Issa M.

AU - Moser, Debra K.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - Background: Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. Hypothesis: Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. Method: A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. Results: There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01–2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. Conclusion: Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.

AB - Background: Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. Hypothesis: Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. Method: A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. Results: There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01–2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. Conclusion: Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.

KW - Health outcome

KW - Heart failure

KW - Inflammation

KW - Obesity

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ER -

The health outcomes of inflammation and obesity in patients with heart failure

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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