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Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index
AIMS: In heart failure with reduced ejection fraction (HFrEF), there is an ‘obesity paradox’, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a sodium–glucose co‐transporter 2 inhibitor according to...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Ltd.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9292627/ https://www.ncbi.nlm.nih.gov/pubmed/34272791 http://dx.doi.org/10.1002/ejhf.2308 |
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author | Adamson, Carly Jhund, Pardeep S. Docherty, Kieran F. Bělohlávek, Jan Chiang, Chern‐En Diez, Mirta Drożdż, Jarosław Dukát, Andrej Howlett, Jonathan Ljungman, Charlotta E.A. Petrie, Mark C. Schou, Morten Inzucchi, Silvio E. Køber, Lars Kosiborod, Mikhail N. Martinez, Felipe A. Ponikowski, Piotr Sabatine, Marc S. Solomon, Scott D. Bengtsson, Olof Langkilde, Anna Maria Lindholm, Daniel Sjöstrand, Mikaela McMurray, John J.V. |
author_facet | Adamson, Carly Jhund, Pardeep S. Docherty, Kieran F. Bělohlávek, Jan Chiang, Chern‐En Diez, Mirta Drożdż, Jarosław Dukát, Andrej Howlett, Jonathan Ljungman, Charlotta E.A. Petrie, Mark C. Schou, Morten Inzucchi, Silvio E. Køber, Lars Kosiborod, Mikhail N. Martinez, Felipe A. Ponikowski, Piotr Sabatine, Marc S. Solomon, Scott D. Bengtsson, Olof Langkilde, Anna Maria Lindholm, Daniel Sjöstrand, Mikaela McMurray, John J.V. |
author_sort | Adamson, Carly |
collection | PubMed |
description | AIMS: In heart failure with reduced ejection fraction (HFrEF), there is an ‘obesity paradox’, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a sodium–glucose co‐transporter 2 inhibitor according to baseline BMI in the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF). METHODS AND RESULTS: Body mass index was examined using standard categories, i.e. underweight (<18.5 kg/m(2)); normal weight (18.5–24.9 kg/m(2)); overweight (25.0–29.9 kg/m(2)); obesity class I (30.0–34.9 kg/m(2)); obesity class II (35.0–39.9 kg/m(2)); and obesity class III (≥40 kg/m(2)). The primary outcome in DAPA‐HF was the composite of worsening heart failure or cardiovascular death. Overall, 1348 patients (28.4%) were under/normal‐weight, 1722 (36.3%) overweight, 1013 (21.4%) obesity class I and 659 (13.9%) obesity class II/III. The unadjusted hazard ratio (95% confidence interval) for the primary outcome with obesity class 1, the lowest risk group, as reference was: under/normal‐weight 1.41 (1.16–1.71), overweight 1.18 (0.97–1.42), obesity class II/III 1.37 (1.10–1.72). Patients with class I obesity were also at lowest risk of death. The effect of dapagliflozin on the primary outcome and other outcomes did not vary by baseline BMI, e.g. hazard ratio for primary outcome: under/normal‐weight 0.74 (0.58–0.94), overweight 0.81 (0.65–1.02), obesity class I 0.68 (0.50–0.92), obesity class II/III 0.71 (0.51–1.00) (P‐value for interaction = 0.79). The mean decrease in weight at 8 months with dapagliflozin was 0.9 (0.7–1.1) kg (P < 0.001). CONCLUSION: We confirmed an ‘obesity survival paradox’ in HFrEF. We showed that dapagliflozin was beneficial across the wide range of BMI studied. Clinical Trial Registration: ClinicalTrials.gov NCT03036124. |
format | Online Article Text |
id | pubmed-9292627 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley & Sons, Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92926272022-07-20 Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index Adamson, Carly Jhund, Pardeep S. Docherty, Kieran F. Bělohlávek, Jan Chiang, Chern‐En Diez, Mirta Drożdż, Jarosław Dukát, Andrej Howlett, Jonathan Ljungman, Charlotta E.A. Petrie, Mark C. Schou, Morten Inzucchi, Silvio E. Køber, Lars Kosiborod, Mikhail N. Martinez, Felipe A. Ponikowski, Piotr Sabatine, Marc S. Solomon, Scott D. Bengtsson, Olof Langkilde, Anna Maria Lindholm, Daniel Sjöstrand, Mikaela McMurray, John J.V. Eur J Heart Fail Focused Issue on Comorbidities AIMS: In heart failure with reduced ejection fraction (HFrEF), there is an ‘obesity paradox’, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a sodium–glucose co‐transporter 2 inhibitor according to baseline BMI in the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF). METHODS AND RESULTS: Body mass index was examined using standard categories, i.e. underweight (<18.5 kg/m(2)); normal weight (18.5–24.9 kg/m(2)); overweight (25.0–29.9 kg/m(2)); obesity class I (30.0–34.9 kg/m(2)); obesity class II (35.0–39.9 kg/m(2)); and obesity class III (≥40 kg/m(2)). The primary outcome in DAPA‐HF was the composite of worsening heart failure or cardiovascular death. Overall, 1348 patients (28.4%) were under/normal‐weight, 1722 (36.3%) overweight, 1013 (21.4%) obesity class I and 659 (13.9%) obesity class II/III. The unadjusted hazard ratio (95% confidence interval) for the primary outcome with obesity class 1, the lowest risk group, as reference was: under/normal‐weight 1.41 (1.16–1.71), overweight 1.18 (0.97–1.42), obesity class II/III 1.37 (1.10–1.72). Patients with class I obesity were also at lowest risk of death. The effect of dapagliflozin on the primary outcome and other outcomes did not vary by baseline BMI, e.g. hazard ratio for primary outcome: under/normal‐weight 0.74 (0.58–0.94), overweight 0.81 (0.65–1.02), obesity class I 0.68 (0.50–0.92), obesity class II/III 0.71 (0.51–1.00) (P‐value for interaction = 0.79). The mean decrease in weight at 8 months with dapagliflozin was 0.9 (0.7–1.1) kg (P < 0.001). CONCLUSION: We confirmed an ‘obesity survival paradox’ in HFrEF. We showed that dapagliflozin was beneficial across the wide range of BMI studied. Clinical Trial Registration: ClinicalTrials.gov NCT03036124. John Wiley & Sons, Ltd. 2021-07-29 2021-10 /pmc/articles/PMC9292627/ /pubmed/34272791 http://dx.doi.org/10.1002/ejhf.2308 Text en © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Focused Issue on Comorbidities Adamson, Carly Jhund, Pardeep S. Docherty, Kieran F. Bělohlávek, Jan Chiang, Chern‐En Diez, Mirta Drożdż, Jarosław Dukát, Andrej Howlett, Jonathan Ljungman, Charlotta E.A. Petrie, Mark C. Schou, Morten Inzucchi, Silvio E. Køber, Lars Kosiborod, Mikhail N. Martinez, Felipe A. Ponikowski, Piotr Sabatine, Marc S. Solomon, Scott D. Bengtsson, Olof Langkilde, Anna Maria Lindholm, Daniel Sjöstrand, Mikaela McMurray, John J.V. Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title | Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title_full | Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title_fullStr | Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title_full_unstemmed | Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title_short | Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
title_sort | efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index |
topic | Focused Issue on Comorbidities |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9292627/ https://www.ncbi.nlm.nih.gov/pubmed/34272791 http://dx.doi.org/10.1002/ejhf.2308 |
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