Abstract 12042: The “Obesity Paradox” in Ambulatory Patients With Heart Failure With Preserved Ejection Fraction
Background: The “obesity paradox”, wherein obesity is a risk factor for development of heart failure (HF) but is associated with better survival in HF, is well described in HF with reduced ejection fraction (HFrEF) and partly attributed to cardiac cachexia. However, cachexia is not usually associated with HF with preserved ejection fraction (HFpEF) and little is known about the existence of the paradox in HFpEF. Accordingly, we examined the prognostic significance of body mass index (BMI) on outcomes in HFpEF.
Methods: We evaluated 2501 ambulatory patients with HFpEF from 153 VA healthcare facilities with 2-year follow-up. Kaplan Meier survival curves and Cox-proportional hazard models were used to examine the association of BMI with outcomes of mortality, HF hospitalization and all cause hospitalization.
Results: In patients with HFpEF (age 71 ± 10 years, 91% males, 89% white), patients with higher BMI were significantly younger, had higher prevalence of hypertension, diabetes, and prior HF hospitalization, but lower prevalence of atrial fibrillation, anemia ((p≤0.001 for all) and chronic kidney disease (p=0.04). Compared to normal weight patients, patients with higher BMI had a lower risk of mortality (Log rank p≤0.001), but higher risk of HF hospitalization (p=0.038) (Figure), and similar risk of all cause hospitalization (p=0.77), which remained significant even after adjusting for baseline differences (Table).
Conclusions: Our study suggests the presence of the “obesity paradox” even in patients with HFpEF, with higher BMI being independently associated with improved survival. However, higher BMI was also associated with a higher risk of HF hospitalizations.
- © 2013 by American Heart Association, Inc.