The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data

Abstract

In patients with chronic HF, the obesity paradox was present in both those with reduced and preserved ventricular systolic function. Mortality in both HF subtypes was U-shaped, with a nadir at 30.0-34.9 kg m(-2).

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

“…1,2,7-9,19, 20 In the present study, we analyzed the subset of HF patients most affected by AF, which included a relatively high percentage of patients with low BMI compared with Western studies. 21- 23 The main findings were as follows: (1) the risk of the composite primary endpoint (all-cause death and re-hospitalization for ADHF) was higher in patients with AF than in those without AF; (2) the incidence rate of the primary endpoint was higher in patients with AF from the HFpEF group, but not the HFrEF group; (3) the incidence rate of the primary endpoint was higher in patients with AF from the HFpEF group who had low-medium BMI; and (4) AF was an independent predictor of the endpoint only in the HFpEF BMI <25 group. Taken together, the prognostic impact of AF might differ in non-obese and obese HFpEF patients.…”

Lowering Body Weight in Obese Mice With Diastolic Heart Failure Improves Cardiac Insulin Sensitivity and Function: Implications for the Obesity Paradox

“…Echocardiographic analyses of in vivo cardiac function were carried out at baseline (4 weeks) and 6,8,14, and 18 weeks of the treatment protocol. Mice were anesthetized with 0.75% isoflurane for the duration of the procedure.…”

“…A low BMI in heart failure patients is associated with decreased survival. This paradoxical association is found in patients with preserved and reduced ejection fraction, with a nadir of mortality in one individual patient meta-analysis (n = 23,967) of 34.0-34.9 kg/m 2 (8). A number of experimental studies have also shown favorable effects of high-fat (HF) diet on cardiac function and survival in different disease states such as myocardial infarction, heart failure, and hypertension (see ref.…”

“…Despite the fact that obesity increases the incidence of heart failure, several studies suggest that there is a protective effect of being obese in patients with heart failure, known as the obesity paradox (7)(8)(9)(10)(11)(12)(13). A low BMI in heart failure patients is associated with decreased survival.…”

Noncardiac Comorbidities in Heart Failure With Preserved Ejection Fraction – A Commonly Ignored Fact –

“…43 Independent of other key prognostic variables for HFPEF patients, there was a U-shaped relationship, with the greatest rate of adverse outcomes in the lowest and highest BMI categories, which was called the "obesity paradox". [40][41][42][43] Although the pathophysiology behind the obesity paradox is unknown, several possible explanations have been proposed. Patients able to maintain a healthy BMI may harbor a favorable inflammatory, hormonal, and metabolic milieu and avert a catabolic state.…”