Evidence mapPaperPMID 39395939Full record

Observational studyBMC cardiovascular disorders2024

Mediation effect analysis of lipoprotein levels on BMI and cardiovascular outcomes in patients with heart failure.

Yi Wang, Xiaoli Liu, Baochuan Wu, Xi Tan, Lin Chen, Heyu Chu, Zeyu Zhou, Xue Bao, Biao Xu, Rong Gu

Abstract readObservational Study
In one paragraph

Observational study in BMC cardiovascular disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yi Wang *Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
Xiaoli Liu *Department of Cardiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road, Nanjing, 210008, China.
Baochuan Wu *Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
Xi TanDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
Lin ChenDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
Heyu ChuDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Zhongshan Road, Nanjing, 210008, China.
Zeyu ZhouDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
Xue BaoDepartment of Cardiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road, Nanjing, 210008, China. baoxue@njglyy.com.
Biao XuDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China. xubiao62@nju.edu.cn.
Rong GuDepartment of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China. gurong.nju@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAmong heart failure patients with obesity, the prognosis is better than those with normal weight, a phenomenon known as the obesity paradox. However, it is unclear whether lipoprotein levels play a mediating role in the machine of the obesity paradox.

methodsThe study included 1663 heart failure patients hospitalized from January, 2019 through August, 2022. Kaplan-Meier survival analysis and Log-rank tests were performed for three endpoints in order to determine cumulative event-free survival. We investigated the correlation between Body Max Index (BMI) and outcomes by multifactorial Cox models. Mediation analysis was applied to study the presence and magnitude of mediation effects of triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 and apolipoprotein B, with the association between BMI and endpoints.

resultsIn MACCEs, the median follow-up period was 679 days. In Cox model, compared with the underweight group, a high BMI level was significantly associated with lower all-cause mortality (HR=0.47, 95%CI 0.31~0.69, p<0.001, obese vs underweight), cardiovascular mortality (HR=0.46, 95%CI 0.30~0.73, p<0.001, obese vs underweight) and the incidence of MACCEs (HR=0.68, 95%CI 0.53~0.88, p=0.003, obese vs underweight). Mediation analysis revealed that TG was the strongest mediator between BMI and endpoints, with proportions of mediated effects of 6.6% (95%CI 2.2%~18.0%, p=0.0258, in all-cause death),7.0% (95%CI 2.3%~18.9%, p=0.0301, in cardiovascular death) and 10.2% (95%CI 3.3%~27.4%, p=0.0185, in MACCEs).

conclusionsThere is an "obesity paradox" in patients with heart failure, and lipoprotein levels especially triglyceride mediate the association between BMI and cardiovascular outcomes.

Indexed as

BiomarkersBody Mass IndexHeart FailureLipoproteinsMediation AnalysisObesityAgedAged, 80 and overFemaleHumansIncidenceMaleMiddle AgedPrognosisProgression-Free SurvivalRetrospective StudiesBiomarkersLipoproteinsHeart failureLipoproteinMediating effectObesity

Identifiers

PMID39395939
PMCPMC11470738

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.