Key result
Clinical obesity linked to ~63% higher new-onset heart failure risk but no excess post-HF mortality.
Why the study?
Clinical obesity is recognized as an independent disease, but its link to heart failure development and subsequent prognosis remains underexplored.
Does clinical obesity increase the risk of new-onset heart failure and subsequent all-cause mortality in a general cohort?
Cohort (n=99,131)
Does clinical obesity increase the risk of new-onset heart failure and subsequent all-cause mortality in a general cohort?
Clinical obesity is a significant independent risk factor for the development of new-onset heart failure, with risk increasing alongside the number of clinical criteria, though it does not appear to worsen all-cause mortality once heart failure has developed.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The authors believe their study 'has significant clinical implications, suggesting that patients with clinical obesity require not only weight reduction but also treatment for obesity-related organ and tissue dysfunctions to mitigate the risk of HF.”
Clinical obesity should prompt HF risk stratification; leaves open whether this association is causal or modifiable by intervention.
BACKGROUND: The Lancet Diabetes & Endocrinology Commission recognizes clinical obesity as an independent disease, although its link to heart failure (HF) remains underexplored. OBJECTIVES: The goal of this study was to evaluate the impact of clinical obesity on new-onset HF risk and subsequent all-cause mortality after the development of HF. METHODS: Clinical obesity was defined based on body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, and 10 clinical criteria. A total of 99,131 participants from the Kailuan Study cohort were classified into nonobese, preclinical obesity, and clinical obesity groups. A Cox proportional hazards model was applied to assess the association between clinical obesity and the risk of new-onset HF, and all-cause mortality was examined among those with HF. RESULTS: Over a median follow-up of 16.0 years, 3,280 participants developed HF, and there were 19,170 deaths from any cause. Compared with the nonobese group, clinical obesity was associated with a 63% higher risk of new-onset HF (adjusted [aHR]: 1.63; 95% CI: 1.49-1.77), with varying risks across HF subtypes. Within the clinical obesity group, HF risk increased with the number of clinical criteria: one (aHR: 1.50; 95% CI: 1.37-1.64), two (aHR: 1.91; 95% CI: 1.70-2.14), and three or more (aHR: 2.20; 95% CI: 1.80-2.68). However, clinical obesity was not associated with increased all-cause mortality after HF (aHR: 1.01; 95% CI: 0.90-1.15). CONCLUSIONS: These findings highlight clinical obesity as a risk factor for new-onset HF and all-cause mortality, driven both by excess weight and associated clinical conditions. Recognizing clinical obesity as an independent disease may support more effective HF prevention strategies.
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Liu et al. (2026) conducted a cohort in Clinical obesity and Heart Failure (n=99,131). Clinical obesity vs. Nonobese was evaluated on New-onset heart failure (aHR 1.63, 95% CI 1.49-1.77). Clinical obesity increased the risk of new-onset heart failure by 63% compared with the nonobese group (aHR 1.63; 95% CI 1.49-1.77), but did not increase all-cause mortality after heart failure.
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