The Impact of Obesity on Cardiovascular Risk in Patients With Preserved Ejection Fraction: Insights From Central Blood Pressure Analysis

Objective: The classic concept of heart failure (HF), pump failure, has now faded and the preserved pump function in HF with preserved ejection fracture (HFpEF) has received more spotlight as we enter an aging society. HFpEF is a syndrome that represents a variety of phenotypes caused by various factors, and recently, its relationship with obesity has drawn attention. In this study, we evaluated the impact of obesity and blood pressure (BP) on cardiovascular (CV) risk in patients with HFpEF. Design and method: From June 2011 to December 2016, a total of 2,910 patients were enrolled and followed up until August 2022. Radial tonometry was used by measurement of central BP (CBP), and skilled personnel who completed validation for inter- and intra-observer variability performed echocardiography examinations. The primary endpoint was a composite outcome of CV disease. Results: A total of 1,993 patients with an EF of 50% or more were included during a median follow-up period of 7.4 years. As body mass index (BMI) increased from normal levels, the occurrence of CV events tended to increase (less than 25 of BMI; 627[61, 9.7%], 23 to 25 of BMI; 511[57, 11.2%], 25 to 28 of BMI; 572 [47, 8.2%], more than 28 of BMI; 283 [35, 12.4%]) and as a result, CBP also tended to increase sequentially. According to the univariate Cox proportional hazard model, the increase of 10 mmHg in CBP was shown to increase the risk of CV events by 20% in patients with a BMI of less than 23, while it was shown to decrease the risk by 18% in patients with a BMI between 25 and 28. However, statistical significance was not achieved for patients with a BMI between 23 and 25 or those with a BMI of 28 or more. Conclusions: In this study, we evaluated that there is an increasing trend in the incidence of CV events with increasing BMI, especially, that patients with lower BMI are important to control BP and CBP.