Cardiology and CTVS

U- Shaped Relationship Observed Between BMI And Mortality Due To Heart Failure

• byDoctor News Daily Team
• 18 February, 2025
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Obesity and Heart Failure (HF) is most closely linked to each other factors causing various complications such as hypertension, left ventricular hypertrophy, inflammation, hyperglycemia, sleep-disordered breathing, and renal dysfunction. However there is limited evidence in community populations across long-term follow-up.

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Nicholas R Jones and team of researchers in a recent study aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort. The study reveals a U-shaped relationship between BMI and long-term all-cause mortality, researchers suggest a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk. The findings are published in journal Heart.

Study included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000–2017). They used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.
The findings of the study are

• Out of 47 531 participants with HF (median age 78.0 years (IQR 70–84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9–31.0)) and 25 013 (52.6%) died during follow-up.
• Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) −4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD −4.5%).
• class II (HR 0.76, 95% CI 0.71 to 0.81, RD −4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%).
• In those underweight, this risk was greater among men than women (p value for interaction=0.02).
• Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).
Jones and team concluded that “The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.”
Reference: Jones NR, Ordóñez-Mena JM, Roalfe AK, et al; Body mass index and survival in people with heart failure, Heart Published Online First: 08 June 2023. doi: 10.1136/heartjnl-2023-322459