Anker, Stefan D., Khan, Muhammad Shahzeb, Butler, Javed, Ofstad, Anne Pernille, Peil, Barbara, Pfarr, Egon, Doehner, Wolfram, Sattar, Naveed, Coats, Andrew J. S., Filippatos, Gerasimos, Ferreira, João Pedro, Zannad, Faiez, Pocock, Stuart and Packer, Milton (2023) Weight change and clinical outcomes in heart failure with reduced ejection fraction : insights from EMPEROR‐Reduced. European Journal of Heart Failure, 25 (1). pp. 117-127. doi:10.1002/ejhf.2728 ISSN 1388-9842.

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Abstract

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/m2 (n = 180); 20 to <25 kg/m2 (n = 1038); 25 to <30 kg/m2 (n = 1345); 30 to <35 kg/m2 (n = 774) and ≥35 kg/m2 (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.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Heart failure, Body mass index , Weight loss
Journal or Publication Title:	European Journal of Heart Failure
Publisher:	John Wiley & Sons Ltd.
ISSN:	1388-9842
Official Date:	January 2023
Dates:	Date Event January 2023 Published 24 November 2022 Available 2 November 2022 Accepted
Volume:	25
Number:	1
Page Range:	pp. 117-127
DOI:	10.1002/ejhf.2728
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	10 January 2023
Date of first compliant Open Access:	11 January 2023
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Boehringer Ingelheim http://dx.doi.org/10.13039/100008349 UNSPECIFIED Eli Lilly and Company http://dx.doi.org/10.13039/100004312 UNSPECIFIED Diabetes Alliance https://www.diabetesalliance.org.za/

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