Body Mass Index, Muscle Mass, and All-Cause Mortality in Patients With Acute Heart Failure: The Obesity Paradox Revisited

Figures

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  Figure 1. Risk of all-cause mortality according to the BMI. (A) All-cause mortality-free survival is shown according to the BMI category: BMI <18.5 kg/m2 (underweight), BMI 18.5–23 kg/m2 (ideal BMI), BMI 23–25 kg/m2 (overweight), BMI 25–30 kg/m2 (obesity class I), and BMI ≥30 kg/m2 (obesity class II). (B) The association of the risk of all-cause mortality with BMI is shown in the spline curve. BMI = body mass index; HR = hazard ratio; CI = confidence interval.

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  Figure 2. Spline curves for all-cause mortality in evaluated subgroups. Multivariable-adjusted spline curves for the all-cause mortality are shown according to the BMI in subgroups divided by (A) age, (B) sex, (C) HTN, (D) DM, (E) AF, (F) IHD, and (G) phenotypes of HF. BMI = body mass index; HTN = hypertension; DM = diabetes mellitus; AF = atrial fibrillation; IHD = ischemic heart disease; HFpEF = heart failure with preserved ejection fraction; HFmrEF = heart failure with mildly reduced ejection fraction; HFrEF = heart failure with reduced ejection fraction.

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  Figure 3. Subgroup analyses for all-cause mortality according to the BMI classification. The adjusted HRs are shown for all-cause mortality in subgroups based on age, sex, hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, and phenotype of HF. Using the patients with BMI >25 kg/m2 (obese) as reference (blue), the HRs of patients with overweight (green), ideal BMI (orange), and underweight (red) are summarized. HR = hazard ratio; CI = confidence interval; BMI = body mass index.

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  Figure 4. Associations between BMI, muscle index, and mortality risk. (A) Cumulative incidence curves are shown for all-cause mortality according to the subgroups divided by BMI and muscle index, among the subset of 579 patients with cystatin C data. The associations of the risk of all-cause mortality with (B) BMI and (C) muscle index are shown in the adjusted spline curves. BMI = body mass index; HR = hazard ratio; CI = confidence interval.