Key result
Obesity was associated with a reduced risk of all-cause death (HR 0.49) in HFpEF patients regardless of atrial fibrillation, though it did not significantly reduce the primary composite outcome.
Why the study?
Whether the obesity paradox exists in heart failure or can be modified by comorbidities remains controversial.
Does higher BMI (overweight or obesity) reduce all-cause death in patients with HFpEF with or without comorbid atrial fibrillation?
Observational (n=1,749)
Yes
Does higher BMI (overweight or obesity) reduce all-cause death in patients with HFpEF with or without comorbid atrial fibrillation?
The 'obesity paradox' is present in patients with HFpEF, where overweight and obesity are associated with a lower risk of all-cause mortality regardless of comorbid atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Obesity paradox observed in HFpEF regardless of AF; supports hypothesis-generating research on BMI-outcome links without altering practice.
Background: Overweight and mildly obese individuals have a lower risk of death than their normal-weight counterparts; this phenomenon is termed “obesity paradox.” Whether this “obesity paradox” exists in patients with heart failure (HF) or can be modified by comorbidities is still controversial. Our current study aimed to determine the association of body mass index (BMI) with outcomes with patients with HF with preserved ejection fraction (HFpEF) with or without coexisting atrial fibrillation (AF). Methods: Patients with HFpEF from the Americas in the TOPCAT trial were categorized into the 3 groups: normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), and obesity (≥30 kg/m 2 ). The Cox proportional-hazards models were used to calculate the adjusted hazard ratios (HRs) and CIs. Results: We identified 1,749 patients with HFpEF, 42.1% of which had baseline AF. In the total population of HFpEF, both overweight (HR = 0.59, 95% CI: 0.42–0.83) and obesity (HR = 0.49, 95% CI: 0.35–0.69) were associated with a reduced risk of all-cause death. Among patients with HFpEF without AF, overweight (HR = 0.51, 95% CI: 0.27–0.95) and obesity (HR = 0.64, 95% CI: 0.43–0.98) were associated with a lower risk of all-cause death. In those with AF, obesity (HR = 0.62, 95% CI: 0.40–0.95) but not overweight (HR = 0.81, 95% CI: 0.54–1.21) was associated with a decreased risk of all-cause death. Conclusions: The “obesity paradox” assessed by BMI exists in patients with HFpEF regardless of comorbid AF. Clinical Trial Registration: https://clinicaltrials.gov , identifier: NCT00094302.
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Guo et al. (2022) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=1,749). Obesity (BMI ≥30 kg/m2) vs. Normal weight (BMI 18.5-24.9 kg/m2) was evaluated on Composite of cardiovascular death, HF hospitalization, or aborted cardiac arrest (HR 0.85, 95% CI 0.61-1.20). Obesity was associated with a reduced risk of all-cause death (HR 0.49) in HFpEF patients regardless of atrial fibrillation, though it did not significantly reduce the primary composite outcome.
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