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The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin.

Wannamethee, SG; Shaper, AG; Whincup, PH; Lennon, L; Papacosta, O; Sattar, N; (2014) The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin. Int J Cardiol , 171 (1) pp. 49-55. 10.1016/j.ijcard.2013.11.043. Green open access

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Abstract

We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. Background: The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). Methods: Prospective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. Results: Overweight (BMI 25–9.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m2) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend]. Conclusion: The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.

Type: Article
Title: The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin.
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijcard.2013.11.043
Publisher version: http://dx.doi.org/10.1016/j.ijcard.2013.11.043
Additional information: © 2013 The Authors. Published by Elsevier Ireland Ltd. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivativeWorks License,which permits non-commercial use, distribution, and reproduction in anymedium, provided the original author and source are credited.
Keywords: BMI, Body mass index, C-reactive protein, CHD, CRP, Cardiovascular disease, Coronary heart disease, HF, Heart failure, Leptin, MAMC, MI, Mid arm muscle circumference, Mortality, Myocardial infarction, N-terminal pro-brain natriuretic peptide, NT-proBNP, Obesity, WC, Waist circumference
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1422330
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