Greater Adiposity Linked to Worse Outcomes in Patients With HFrEF

WEDNESDAY, March 22, 2023 (HealthDay News) -- For patients with heart failure with reduced ejection fraction (HFrEF), waist-to-height ratio shows no evidence for an obesity-survival paradox, according to a study published online March 21 in the European Heart Journal.

Jawad H. Butt, M.D., from the University of Glasgow in the United Kingdom, and colleagues compared the prognostic value of newer anthropometric indices with that of body mass index (BMI) in patients with HFrEF.

The researchers identified an "obesity-survival paradox," with lower mortality risk for those with BMI ≥25 kg/m² versus normal weight; however, after adjustment for other prognostic variables, this finding was eliminated. The paradox was less evident for waist-to-height ratio and was eliminated by adjustment (adjusted hazard ratio for all-cause mortality, 1.10 [95 percent confidence interval, 0.87 to 1.39] for quintile 5 versus 1). Both BMI and waist-to-height ratio showed that greater adiposity was associated with an increased risk for the primary outcome (heart failure hospitalization or cardiovascular death) and heart failure hospitalization; the association was stronger for waist-to-height ratio and persisted after adjustment (e.g., adjusted hazard ratio for heart failure hospitalization, 1.39 [95 percent confidence interval, 1.06 to 1.81] for quintile 5 versus 1 of waist-to-height ratio).

"Our study shows there is no 'obesity survival paradox' when we use better ways of measuring body fat," a coauthor said in a statement. "It is indices that do not include weight, such as waist-to-height ratio, that have clarified the true relationship between body fat and patient outcomes in our study, showing that greater adiposity is actually associated with worse not better outcomes."

Several authors disclosed financial ties to the pharmaceutical industry.

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