Obesity as a prognostic factor in chronic symptomatic heart failure

Background: Obesity is considered as an independent risk factor for development of heart failure (HF); however, its role in the progression of HF independent of atherosclerotic heart disease, hypertension, and diabetes is not well described. Methods: To identify the role of obesity in HF outcomes, we analyzed the Digitalis Investigation Group database with 7788 patients with chronic stable HF. Subjects with body mass index of ≥18.5 and <25 kg/m² were categorized as normal weight, ≥25.0 and <30 kg/m² as overweight, and ≥30.0 kg/m² as obese. Results: Compared with normal weight, overweight or obese patients had lower all-cause mortality (37.8%, 32.4%, and 28.5%, P < .0001) and lower HF mortality (38.7%, 31.2%, and 33.6%, P = .01). After adjustment for differences in baseline characteristics, the overweight (HR 0.87, 95% CI 0.79-0.95, P = .002) and the obese (HR 0.82, 95% CI 0.73-0.92, P = .0005) had better survival rates compared with normal-weight groups. Similarly, the overweight (HR 0.76, 95% CI 0.65-0.88, P = .0003) or the obese (HR 0.79, 95% CI 0.63-0.88, P = .005) patients had better HF survival rates. After adjustment for baseline differences, the rate of hospitalizations was similar in the 3 groups. Conclusions: In patients with chronic symptomatic HF, obesity or overweight status was associated with a lower risk for mortality but a similar risk for hospitalization compared with normal weight status. Prospective studies evaluating the risks and benefits of sustenance of obesity or weight loss are needed in this population.