A U‐shaped association of body mass index and all‐cause mortality in heart failure patients: A dose‐response meta‐analysis of prospective cohort studies

Summary Background and Aims The role of body mass index (BMI) for the prognosis of heart failure (HF) patients remains to be a great interest for a long time. However, the precise effect of dose‐response for BMI and mortality risk in patients with HF is still unclear. We conducted a dose‐response meta‐analysis to quantitatively assess the effect of BMI on all‐cause mortality in subjects with HF. Methods Fourteen prospective cohort studies included 13 508 death cases identified among 46 794 patients with HF. Results The summary HR per 5 units increase in BMI was 0.95 (95% CI=0.92‐0.97) with evidence of high heterogeneity (I 2 =90.10%, P heterogeneity <.00001), and an U‐shaped nonlinear relationship of BMI and risk of mortality from all‐causes was revealed ( P nonlinearity =.0025). When stratified analyses were conducted, the heterogeneity in patients with HF aged more than 60 years decreased. Conclusion Heart failure patients with higher BMI (>28 kg/m 2 ) have a better survival, whereas underweight and those with severe obesity (eg, BMI>37 kg/m 2 ) have a higher mortality.