Author + information
- Received March 30, 2019
- Revision received April 24, 2019
- Accepted April 25, 2019
- Published online July 10, 2019.
- Masatoshi Minamisawa, MD, PhDa,b,∗,
- Sara B. Seidelmann, MD, PhDa,∗,
- Brian Claggett, PhDa,
- Sheila M. Hegde, MD, MPHa,
- Amil M. Shah, MD, MPHa,
- Akshay S. Desai, MD, MPHa,
- Eldrin F. Lewis, MD, MPHa,
- Sanjiv J. Shah, MDc,
- Nancy K. Sweitzer, MDd,
- James C. Fang, MDe,
- Inder S. Anand, MDf,
- Eileen O’Meara, MDg,
- Jean-Lucien Rouleau, MDg,
- Bertram Pitt, MDh and
- Scott D. Solomon, MDa,∗ ()
- aCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- bDepartment of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
- cDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- dDivision of Cardiovascular Medicine, University of Arizona, Tuscon, Arizona
- eDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- fMinneapolis Veterans’ Affairs Hospital, Minneapolis, Minnesota
- gMontreal Heart Institute, Montreal, Quebec, Canada
- hDepartment of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Scott D. Solomon, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts.
Objectives This study sought to investigate the relationship between malnutrition and adverse cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF).
Background Malnutrition is associated with poor prognosis in a wide range of illnesses, however, the prognostic impact of malnutrition in HFpEF patients is not well known.
Methods Baseline malnutrition risk was determined in 1,677 patients with HFpEF enrolled in the Americas regions of the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial, according to 3 categories of the geriatric nutritional risk index (GNRI) as previously validated: moderate to severe, GNRI of <92; low, GNRI of 92 to <98; and absence of risk, GNRI of ≥98. The relationships between malnutrition risk and the primary composite outcome of CV events (CV death, heart failure hospitalization, or resuscitated sudden death) and all-cause death were examined.
Results Approximately one-third of patients were at risk for malnutrition (moderate to severe: 11%; low: 25%; and absence of risk: 64%). Over a median of 2.9-years’ follow-up, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the primary outcome, CV death and all-cause death (hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 1.02 to 1.76; HR: 2.06; 95% CI: 1.40 to 3.03; and HR: 1.79; 95% CI: 1.33 to 2.42, respectively) after multivariate adjustment for age, sex, history of CV diseases, and laboratory biomarkers.
Conclusions Patients with HFpEF are at an elevated risk for malnutrition, which was associated with an increased risk for CV events in this population.
↵∗ Dr. Minamisawa and Seidelmann are joint first authors.
Supported by U.S. National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) contract HH-SN268200425207C. The content of this article does not necessarily represent the views of the National Heart, Lund, and Blood Institute or of the Department of Health and Human Services. Dr. Minamisawa received support from the Japanese Circulation Society, the Japanese Society of Echocardiography, and the Uehara Memorial Foundation Overseas Research Fellowship. Dr. Shah has personal fees from Philips Ultrasound and Bellerophon Therapeutics and research support from Novartis. Dr. Desai is a consultant for Novartis, Abbott, AstraZeneca, Boston Scientific, Boehringer Ingelheim, Regeneron, Relypsa, Corvidia, and Zogenix. Dr. Pitt is a consultant for Bayer and AstraZeneca. Dr. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Novartis, Sanofi, Pasteur, and Theracos; and is a consultant for Akros, Alnylam, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardior, Corvia, Cytokinetics, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, and Tenaya. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 30, 2019.
- Revision received April 24, 2019.
- Accepted April 25, 2019.
- 2019 American College of Cardiology Foundation
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