The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.

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Background The relation between central obesity and survival in community-dwelling adults with a normal body mass index (BMI) is not well known. Objectives To examine the risk of total and cardiovascular mortality associated with central obesity but normal BMI Design Stratified multistage probability design Setting Third National Health and Nutrition Examination Survey Participants We analyzed data on 15,184 people (52.3% women) aged 18 to 90 years.. Measurements We used multivariable Cox proportional hazards model to evaluate the relation of obesity patterns defined by BMI and WHR and total and cardiovascular mortality risk after adjustment for confounding factors. Results Persons with normal-weight central obesity had the worst long-term survival: a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53–2.29]) and twice the mortality risk of participants who were overweight or obese by BMI only (HR, 2.24 [95% CI,1.52–3.32] and HR, 2.42 [95% CI, 1.30–4.53], respectively). Similarly, women with normal weight and central obesity had higher mortality risk than both women with similar BMI but no central obesity (HR, 1.48 [95% CI, 1.35–1.62]) and women who were obese by BMI only (HR, 1.32 [95% CI, 1.15–1.51]). Expected survival estimates were consistently lower for those with central obesity when controlled for age and BMI. Limitations Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion Normal-weight central obesity defined by WHR is associated with higher mortality than BMI–defined obesity, particularly in the absence of central fat distribution.