Obesity Paradox True for Heart Failure Patients?
The results of a recent study suggest that the “obesity paradox” for 30-day mortality exists at every BMI level among patients with heart failure (HF) with reduced ejection fraction (HFrEF), but not among patients with HF with preserved ejection fraction (HFpEF).
Evidence of the existence of an obesity paradox—in which patients with HF have better prognoses at higher weights—is controversial. Using data from Get With The Guidelines-Heart Failure (N = 39,647), the researchers examined the relationship between BMI and in-hospital mortality using logistic regression modeling, and assessed 30-day and 1-year rates of all-cause mortality following discharge with Cox regression modeling.
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Of the 39,647 participants, 59.7% had HFpEF and 30.7% were obese. Class I or higher obesity (BMI ≥30 kg/m2) was more common among black and Hispanic patients than in whites, Asians, or other racial/ethnic groups. Among those with HFpEF, higher BMI was linked to lower 30-day mortality up to 30 kg/m2, followed by a small increase in risk above 30 kg/m2. Only a modest relationship was observed in patients with HFrEF, with no risk above 30 kg/m2.
“Higher BMI was associated with lower 30-day mortality across racial/ethnic groups in a manner inconsistent with the J-shaped relationship noted for coronary artery disease. The differential slope of obesity and mortality among HFpEF and patients with HFrEF potentially suggests differing mechanistic factors, requiring further exploration,” the researchers conluded.
—Michael Potts
Reference:
Powell-Wiley TM, Ngwa J, Kebede S, et al. Impact of body mass index on heart failure by race/ethnicity from the Get With The Guidelines–Heart Failure (GWTG–HF) Registry [published online March 2018]. JACC Heart Failure. doi:10.1016/j.jchf.2017.11.011.