Original articleBody Composition and Mortality in a Large Cohort With Preserved Ejection Fraction: Untangling the Obesity Paradox
Section snippets
Study Design
The study was based on relevant demographic, clinical, and echocardiographic data from a clinical echocardiographic report database that were recorded at the Ochsner Medical Center (New Orleans, Louisiana) between October 7, 1997, and November 20, 2002. We specifically evaluated patients with preserved systolic function (defined as left ventricular ejection fraction [LVEF] ≥50%) who were US residents, resulting in 47,865 studies. Survival was determined by using the National Death Index during
Baseline Characteristics
The study population consisted of 47,865 patients (21,568 obese patients [55%]), 45% of whom were men. The mean age of the cohort was 62±15.4 years. According to the BMI (29±7 kg/m2), patients were overweight, and the mean LMI was 18±3 kg/m2. The mean follow-up time was 633 days. Mortality in the course of this study was 7.6% for the total population (Table 1). When stratified by obesity defined by BMI, the obese population of the cohort reported significantly higher blood pressure, BF, and
Discussion
There were several important findings in this study. First, we confirmed the presence of a U-shaped BMI-mortality curve in this population, in which the lowest adjusted mortality was found in the mildly obese (Figure 1). Second, we found a survival benefit associated with high LMI that was independent of any effect of BF and was present in the lean and the obese population (Table 2). Third, we found a protective effect associated with BF in the overall population and, more specifically, the
Conclusion
Body composition plays a critical role in the obesity paradox. Whenever examining a potential protective effect of BF, LMI should be considered. At higher BMI, BF is associated with an increase in mortality.
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