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Body Mass Index and Outcomes in Patients With Heart Failure

Jeptha P. Curtis, MD; Jared G. Selter, MD; Yongfei Wang, MS; Saif S. Rathore, MPH; Ion S. Jovin, MD; Farid Jadbabaie, MD; Mikhail Kosiborod, MD; Edward L. Portnay, MD; Seth I. Sokol, MD; Feras Bader, MD; Harlan M. Krumholz, MD

Arch Intern Med. 2005;165:55-61.

Background  In the general population, obesity is associated with increased risk of adverse outcomes. However, studies of patients with chronic disease suggest that overweight and obese patients may paradoxically have better outcomes than lean patients. We sought to examine the association of body mass index (BMI) and outcomes in stable outpatients with heart failure (HF).

Methods  We analyzed data from 7767 patients with stable HF enrolled in the Digitalis Investigation Group trial. Patients were categorized using baseline BMI (calculated as weight in kilograms divided by the square of height in meters) as underweight (BMI <18.5), healthy weight (BMI, 18.5-24.9, overweight (BMI, 25.0-29.9), and obese (BMI 30.0). Risks associated with BMI groups were evaluated using multivariable Cox proportional hazards models over a mean follow-up of 37 months.

Results  Crude all-cause mortality rates decreased in a near linear fashion across successively higher BMI groups, from 45.0% in the underweight group to 28.4% in the obese group (P for trend <.001). After multivariable adjustment, overweight and obese patients were at lower risk for death (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.80-0.96, and HR, 0.81; 95% CI, 0.72-0.92, respectively), compared with patients at a healthy weight (referent). In contrast, underweight patients with stable HF were at increased risk for death (HR 1.21; 95% CI, 0.95-1.53).

Conclusions  In a cohort of outpatients with established HF, higher BMIs were associated with lower mortality risks; overweight and obese patients had lower risk of death compared with those at a healthy weight. Understanding the mechanisms and impact of the "obesity paradox" in patients with HF is necessary before recommendations are made concerning weight and weight control in this population.

Author Affiliations: Department of Medicine, Section of Cardiovascular Medicine (Drs Curtis, Selter, Jovin, Jadbabaie, Kosiborod, Portnay, Sokol, Bader, and Krumholz and Messrs Wang and Rathore); Department of Epidemiology and Public Health, Section of Health Policy and Administration, The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, and The Center for Outcomes Research and Evaluation (Dr Krumholz), Yale-New Haven Hospital, New Haven, Conn.

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