April 25, 2025European Heart Journal
Obesity, metrics of central adiposity, and prognostic significance in heart failure with preserved and mildly reduced ejection fraction
Key result
Study evaluates the prognostic significance of obesity and central adiposity in HFpEF and HFmrEF.
Key Points
- To evaluate the prevalence and prognostic significance of central adiposity metrics relative to general obesity in heart failure with preserved and mildly reduced ejection fraction.
- Editorial commentary evaluating findings from a secondary analysis of the PARAGON-HF clinical trial.
- Assessment of anthropometric indices of central adiposity compared to body mass index for predicting adverse clinical outcomes.
- Highlights a near-universal prevalence of central adiposity among patients presenting with heart failure with preserved ejection fraction.
- Underscores that abdominal fat metrics provide independent prognostic information regarding cardiovascular risk that standard body mass index fails to capture.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In this issue of the European Heart Journal, Peikert et al., have used data from the PARAGON-HF trial to explore the prevalence of obesity and its prognostic associations in a HFpEF/HFmrEF population, using both the BMI and WHtR. The authors found that although about half of the patients included in the trial were considered obese based on a BMI ≥ 30 kg/m2, nearly every patient (96%) had central adiposity based on a WHtR ≥0.5. Furthermore, both increasing BMI and increasing WHtR were associated with higher risk of total HF hospitalizations, but these events were more closely related to WHtR than to BMI.”
“The authors believe that this analysis further emphasizes the limitations inherent to BMI as a metric of dysfunctional adipose tissue and challenges the concept of an obesity HFpEF/HFmrEF subphenotype.”
“In conclusion, while BMI will be likely to remain the most commonly used tool to classify and screen for obesity, a more nuanced approach to phenotype and treat obesity in HFpEF/HFmrEF is warranted. By incorporating additional metrics of central adiposity and continuing to refine our understanding of obesity-associated subphenotypes, we can improve both the diagnosis and treatment of these patients, ultimately leading to better outcomes in this growing population.”
Implication
Central adiposity may identify higher-risk HFpEF/HFmrEF patients; leaves open whether targeting it improves outcomes.
Abstract
This editorial refers to ‘Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial’, by A. Pe
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Cite This Study
Marques et al. (2025) studied this question. Central adiposity has a near-universal prevalence among patients with heart failure with preserved ejection fraction.