Effect of Obesity on Response to Spironolactone in Patients With Heart Failure With Preserved Ejection Fraction.

Pubmed ID: 33529620

Pubmed Central ID: PMC8038969

Journal: The American journal of cardiology

Publication Date: May 1, 2021

Affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address: stavros-stavrakis@ouhsc.edu.

MeSH Terms: Humans, Male, Female, Aged, United States, Prevalence, Heart Failure, Treatment Outcome, Prospective Studies, Prognosis, Comorbidity, Stroke Volume, Diuretics, Double-Blind Method, Obesity, Spironolactone

Grants: R25 MD011564, R21 AG057879

Authors: Butler J, Elkholey K, Papadimitriou L, Thadani U, Stavrakis S

Cite As: Elkholey K, Papadimitriou L, Butler J, Thadani U, Stavrakis S. Effect of Obesity on Response to Spironolactone in Patients With Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2021 May 1;146:36-47. Epub 2021 Jan 30.

Studies:

Abstract

Obesity is common in heart failure with preserved ejection fraction (HFpEF). Whether obesity modifies the response to spironolactone in patients with HFpEF remains unclear. We aimed to investigate the effect of obesity, defined by body mass index (BMI) and waist circumference (WC), on response to spironolactone in patients with HFpEF enrolled in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. This was a post-hoc, exploratory analysis of the Americas cohort of Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. BMI≥30 kg/m2 was used to define the obese group and WC≥102 cm in men and ≥88 cm in women were defined as high WC. In separate analyses, BMI and WC were treated as continuous variables. The effect of spironolactone versus placebo on outcomes was calculated by BMI and WC using Cox proportional hazard models. Obese patients were younger and had more co-morbidities. In multivariate analysis, spironolactone use was associated with a significant reduction in the primary end point, compared with placebo in obese [hazard ratio (HR = 0.618, 95% CI 0.460 to 0.831, p = 0.001), but not in nonobese subjects (HR = 0.946, 95% CI 0.623 to 1.437, p = 0.796; p for interaction = 0.056). There was a linear association between continuous BMI and the effect of spironolactone, with the effect becoming significant at 33kg/m<sup>2</sup>. Similar results were obtained for the WC-based analysis. In conclusion, use of spironolactone in obese patients with HFpEF was associated with a decreased risk of the primary end point, cardiovascular death and HF hospitalizations, compared with placebo. Further prospective randomized studies in obese subjects are required.