Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
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.
In: European Journal of Heart Failure, Vol. 23, No. 10, 2021, p. 1662-1672.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index
AU - Adamson, Carly
AU - Jhund, Pardeep S
AU - Docherty, Kieran F
AU - Bělohlávek, Jan
AU - Chiang, Chern-En
AU - Diez, Mirta
AU - Drożdż, Jarosław
AU - Dukát, Andrej
AU - Howlett, Jonathan
AU - Ljungman, Charlotta E A
AU - Petrie, Mark C
AU - Schou, Morten
AU - Inzucchi, Silvio E
AU - Køber, Lars
AU - Kosiborod, Mikhail N
AU - Martinez, Felipe A
AU - Ponikowski, Piotr
AU - Sabatine, Marc S
AU - Solomon, Scott D
AU - Bengtsson, Olof
AU - Langkilde, Anna Maria
AU - Lindholm, Daniel
AU - Sjöstrand, Mikaela
AU - McMurray, John J V
N1 - Publisher Copyright: © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2021
Y1 - 2021
N2 - 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/m2); normal weight (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2); obesity class I (30.0–34.9 kg/m2); obesity class II (35.0–39.9 kg/m2); and obesity class III (≥40 kg/m2). 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.
AB - 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/m2); normal weight (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2); obesity class I (30.0–34.9 kg/m2); obesity class II (35.0–39.9 kg/m2); and obesity class III (≥40 kg/m2). 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.
KW - Adiposity
KW - Body mass index
KW - Dapagliflozin
KW - Heart failure
KW - Obesity
KW - SGLT2 inhibitor
U2 - 10.1002/ejhf.2308
DO - 10.1002/ejhf.2308
M3 - Journal article
C2 - 34272791
AN - SCOPUS:85111530103
VL - 23
SP - 1662
EP - 1672
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1567-4215
IS - 10
ER -
ID: 303042186