Objective Abnormal body mass index (BMI) is associated with higher mortality in various cardiovascular cohorts. The prognostic implications of BMI in adults with congenital heart disease (ACHD) are unknown. We aim to assess the distribution of BMI and its association with symptoms and survival in the ACHD population.
Methods We included 3069 ACHD patients (median age 32.6 years) under follow-up at our institution between 2001 and 2015. Patients were classified based on BMI as underweight (<18.5), normal weight (18.5–25), overweight (25–30) or obese (>30), and symptoms, exercise capacity and mortality were assessed.
Results Overall, 6.2% of patients were underweight, 51.1% had normal weight, 28.2% were overweight and 14.6% were obese. Higher BMI values were associated with lower all-cause and cardiac mortality on univariable Cox analysis, and this effect persisted after adjustment for age, defect complexity, cyanosis and objective exercise capacity. Higher BMI was especially associated with better prognosis in symptomatic ACHD patients (HR 0.94 (95% CI 0.90 to 0.98), p=0.002) and those with complex underlying cardiac defects (HR 0.96 (95% CI 0.91 to 0.997), p=0.048) In patients with a complex cardiac defect who had repeated weight measurements, weight loss was also associated with a worse survival (HR 1.82 (95% CI 1.02 to 3.24), p=0.04).
Conclusions ACHD patients with a higher BMI had a lower mortality. The association between BMI and mortality was especially pronounced in symptomatic patients with complex underlying cardiac defects, suggesting that cardiac cachexia may play a role. Indeed, weight loss in complex ACHD patients was linked to an even higher mortality.
- Adult Congenital Heart Disease
- Body Mass Index
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Contributor GPD and MB planned and conducted the study and are responsible for the overall content as guarrantors. KD, AK, LS, EL, RAG and AU made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. HB and MG made substantial contribution in analysis, drafting the article and revising it critically for important intellectual content. All authors gave final approval of the version to be submitted and any revised version.
Funding This study was supported by a research grant from the EMAH Stiftung Karla Voellm, Krefeld, Germany. GPD, AK, KD, MG and the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK have received support by Actelion UK, Pfizer UK, GSK UK, the British Heart Foundation and the NIHR Cardiovascular and Respiratory Biomedical Research Units.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.