Obesitas paradox niet bij patiënten met hartfalen én diabetes
Obesity confers no benefit in patients with HF and diabetes
Patients with mild to moderate heart failure (HF) who also have Type 2 diabetes gain no apparent survival benefit from being obese, show study results.
These findings are in contrast with previous results obtained for obese nondiabetics with HF showing a paradoxical survival benefit in these patients compared with nonobese individuals with HF.
As obesity complicates treatment for Type 2 diabetes, Ali Ahmed (University of Alabama at Birmingham, USA) and colleagues assessed whether the "obesity paradox" was present in patients with HF and diabetes.
They report results from 7788 patients with chronic mild to moderate HF with a body mass index (BMI) above 20 kg/m2, 2153 (29%) of whom had Type 2 diabetes. The participants were followed up for 38 months on average.
Overall, 798 (37%) and 1162 (22%) of the diabetic and nondiabetic patients, respectively, were obese (BMI of 30 kg/m2 or above) at baseline. Obese and nonobese pairs with and without diabetes were compared by the researchers.
Writing in the European Journal of Heart Failure, the team reports that all-cause mortality occurred in 38% of obese and 39% of nonobese patients with HF and diabetes.In contrast, 23% of obese versus 27% of nonobese patients with HF but no diabetes died from any cause over the follow-up period, a statistically significant difference.
"The lack of association between obesity and mortality in HF patients with diabetes mellitus is intriguing," say Ahmed and team."Recent evidence suggests that obesity may not be an independent predictor of mortality but its effects are mediated through variables such as diabetes mellitus and hypertension which are on the biological pathway of obesity and cardiovascular disease," they explain.
"Therefore, it is possible that the presence of diabetes mellitus is a much stronger predictor of outcome than obesity per se and largely offsets any effect of obesity, even a protective one. This hypothesis is further corroborated by the striking difference in mortality between obese patients with and without diabetes mellitus."