Relationship between waist‐to‐height ratio and heart failure outcome: A single‐centre prospective cohort study

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2024-09-17 DOI:10.1002/ehf2.15029

Ping Wang, Yang Zhao, Danni Wang, Boxiang Wang, Hange Liu, Guotao Fu, Ling Tao, Gang Tian

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Abstract

AimsThis study sought to evaluate the correlation between waist‐to‐height ratio (WHtR) and heart failure (HF) outcomes across different ejection fraction (EF) categories.Methods and resultsA prospective cohort study was conducted at a comprehensive tertiary hospital in China. The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow‐up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all‐cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all‐cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 ± 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (≥0.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 ± 1.55 vs. 3.36 ± 0.90 mmol/L), TG (1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L), and LDL‐C (2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L) compared with patients with low WHtR (<0.50). NT‐proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow‐up period. The incidence of all‐cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30–2.58), 1.96 (1.34–2.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF/low WHtR exhibited a markedly elevated risk of all‐cause mortality [HR = 2.31; (95% CI: 1.24–4.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92–8.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19–17.76)] compared with patients with HFrEF/high WHtR. WHtR has a negligible effect on the risk of all‐cause and cardiovascular mortality in heart failure patients with preserved EFs.ConclusionsThe obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF.

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腰围身高比与心衰预后之间的关系：单中心前瞻性队列研究

目的本研究旨在评估不同射血分数（EF）类别的腰围身高比（WHtR）与心力衰竭（HF）预后之间的相关性。方法和结果在中国一家综合性三级医院开展了一项前瞻性队列研究。参与者按 WHtR 和 EF 四分位进行分类。心衰确诊后每 6 个月进行一次门诊或电话随访。主要终点是48个月的全因死亡率。采用 Cox 比例危险回归分析评估 WHtR 与全因死亡率之间的关系。在859名注册参与者中，545人（63.4%）为男性，平均年龄为（65.2 ± 11.1）岁。在对年龄和性别进行调整后，WHtR 与体重指数（相关性 = 0.703，P = 0.000）和 WHR（相关性 = 0.609，P = 0.000）均有很强的相关性。WHtR 高（≥0.50）的人患高血压（56.4% vs. 39.6%）和糖尿病（26.5% vs. 13.7%）的比例更高，TC 水平更高（3.61 ± 1.55 vs. 3.36 ± 0.90 mm）。与低 WHtR（<0.50）患者相比，高 TC（3.36 ± 0.90 mmol/L）、高 TG（1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L）和低密度脂蛋白胆固醇（2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L）水平更高。在低 WHtR 组和高 WHtR 组中，NT-proBNP 水平均与 EF 值成反比。共有 149 名（18.9%）患者在随访期结束时死亡。与高 WHtR 组相比，低 WHtR 组的全因死亡和心血管死亡发生率更高[HRs = 1.83 (1.30-2.58)，1.96 (1.34-2.88)]。两组患者的非心血管死亡率或再住院率无明显差异。与 HFrEF/高 WHtR 患者相比，HFrEF/低 WHtR 患者的全因死亡率[HR = 2.31；（95% CI：1.24-4.30）]、心衰死亡率[HR = 3.52；（95% CI：2.92-8.80）]和非心血管死亡率[HR = 4.59；（95% CI：1.19-17.76）]风险明显升高。WHtR对EF保持不变的心衰患者全因和心血管死亡风险的影响微乎其微。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.