Body Mass Index, Valsartan, and Myocardial Remodeling in Early-Stage Hypertrophic Cardiomyopathy: A Secondary Analysis of the Randomized VANISH Trial.

In 30 seconds

This post hoc analysis of the randomized, multicenter VANISH trial examined BMI and cardiac remodeling in participants with early-stage hypertrophic cardiomyopathy. Of 171 participants, 52% had elevated BMI. After adjustment, higher baseline BMI was associated with poorer exercise capacity and cardiac function, greater left ventricular mass and chamber volumes, and greater likelihood of developing late gadolinium enhancement over 2 years (adjusted odds ratio, 3.6 [95% CI, 1.1-11.9]). BMI did not appear to modify valsartan’s effect on cardiac remodeling. The findings link elevated and increasing BMI with greater phenotypic progression, but do not establish causation.

Key findings

• Elevated BMI was present in 89 of 171 participants (52%).
• Elevated BMI was associated with greater likelihood of late gadolinium enhancement over 2 years (adjusted odds ratio, 3.6 [95% CI, 1.1-11.9]; P =0.033).
• Greater 2-year BMI increases were associated with larger declines in peak oxygen uptake and greater increases in left ventricular mass.
• Valsartan modestly attenuated weight gain versus placebo (adjusted mean difference, -3.1% [95% CI, -6.2 to -0.1%]; P =0.042), but baseline BMI did not modify its effect on cardiac remodeling (P interaction =0.96).

Why it matters

In early-stage hypertrophic cardiomyopathy, BMI may help identify patients with a more adverse remodeling profile, while changes in BMI may track with phenotypic progression. These associations support attention to weight as a potentially relevant factor in disease evolution, although the analysis cannot show that reducing BMI will prevent progression.

What to keep in mind

This was a post hoc analysis of a randomized trial; BMI associations were observational and do not establish causation. The cohort was young and 97% White, which may limit generalizability.