Weight change and clinical outcomes in heart failure with reduced ejection fraction: insights from EMPEROR-Reduced.

Autor: Anker SD; Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.; Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland., Khan MS; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA., Butler J; Baylor Scott and White Research Institute, Dallas, TX, USA.; Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA., Ofstad AP; Medical Department, Boehringer Ingelheim Norway KS, Asker, Norway.; Oslo Diabetes Research Center, Oslo, Norway., Peil B; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany., Pfarr E; Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany., Doehner W; Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany., Sattar N; School of Cardiovascular and Metabolic Health University of Glasgow, BHF Glasgow Cardiovascular Research Centre (GCRC), Glasgow, UK., Coats AJS; University of Warwick, Coventry, UK., Filippatos G; National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece., Ferreira JP; Centre d'Investigation Clinique-Plurithématique INSERM CIC-P 1433, and INSERM U1116 CHRU Nancy Brabois F-CRIN INI-CRCT, Université de Lorraine, Nancy, France.; UnIC@RISE, Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal., Zannad F; Centre d'Investigation Clinique-Plurithématique INSERM CIC-P 1433, and INSERM U1116 CHRU Nancy Brabois F-CRIN INI-CRCT, Université de Lorraine, Nancy, France., Pocock S; London School of Hygiene and Tropical Medicine, London, UK., Packer M; Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.; Imperial College, London, UK.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2023 Jan; Vol. 25 (1), pp. 117-127. Date of Electronic Publication: 2022 Nov 24.
DOI: 10.1002/ejhf.2728
Abstrakt: Aims: Baseline body mass index (BMI) and weight loss promoted by sodium-glucose cotransporter 2 inhibitors may impact outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We assessed in the EMPEROR-Reduced population treated with empagliflozin versus placebo the relationship between baseline BMI, weight loss and effects on the primary (time to first hospitalization for heart failure [HHF] or cardiovascular death) and key secondary outcomes.
Methods and Results: We categorized patients according to their baseline BMI: <20 kg/m 2 (n = 180); 20 to <25 kg/m 2 (n = 1038); 25 to <30 kg/m 2 (n = 1345); 30 to <35 kg/m 2 (n = 774) and ≥35 kg/m 2 (n = 393). The treatment effect of empagliflozin on the primary outcome was consistent across all BMI categories (hazard ratios in subgroups 0.66-0.88, interaction trend p = 0.32), as was the effect on total (first plus recurrent) HHF (interaction trend p = 0.31). Empagliflozin reduced the rate of estimated glomerular filtration rate decline consistently across the BMI categories (interaction trend p = 0.67). Overall, incidence rates of any or serious adverse events were comparable between the treatment groups across all BMI categories. A total of 313 (17.4%) patients treated with empagliflozin experienced a weight loss of more than 5% at week 52 versus 230 (12.8%) in placebo. When analysed separately within each treatment group, presence of weight loss was similarly associated with an increased risk of all-cause mortality.
Conclusion: The benefits of empagliflozin versus placebo were consistently present across all BMI categories in HFrEF patients. Weight loss was associated with higher risk of all-cause mortality, regardless of treatment group.
(© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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