The “Obesity Paradox” in Patients With HFpEF With or Without Comorbid Atrial Fibrillation

Abstract

Background: Overweight and mildly obese individuals have a lower risk of death than their normal-weight counterparts; this phenomenon is termed “obesity paradox.” Whether this “obesity paradox” exists in patients with heart failure (HF) or can be modified by comorbidities is still controversial. Our current study aimed to determine the association of body mass index (BMI) with outcomes with patients with HF with preserved ejection fraction (HFpEF) with or without coexisting atrial fibrillation (AF).Methods: Patients with HFpEF from the Americas in the TOPCAT trial were categorized into the 3 groups: normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30 kg/m2). The Cox proportional-hazards models were used to calculate the adjusted hazard ratios (HRs) and CIs.Results: We identified 1,749 patients with HFpEF, 42.1% of which had baseline AF. In the total population of HFpEF, both overweight (HR = 0.59, 95% CI: 0.42–0.83) and obesity (HR = 0.49, 95% CI: 0.35–0.69) were associated with a reduced risk of all-cause death. Among patients with HFpEF without AF, overweight (HR = 0.51, 95% CI: 0.27–0.95) and obesity (HR = 0.64, 95% CI: 0.43–0.98) were associated with a lower risk of all-cause death. In those with AF, obesity (HR = 0.62, 95% CI: 0.40–0.95) but not overweight (HR = 0.81, 95% CI: 0.54–1.21) was associated with a decreased risk of all-cause death.Conclusions: The “obesity paradox” assessed by BMI exists in patients with HFpEF regardless of comorbid AF.Clinical Trial Registration:https://clinicaltrials.gov, identifier: NCT00094302.

Prognostic Impact of Body Mass Index in Atrial Fibrillation

“…In light of the aforementioned reasoning, purposeful weight loss seems to be of pivotal importance in patients with established AF (apart from the ones with concomitant HF [ 43 , 44 , 45 ])—as proposed in the ESC recommendations for AF management [ 46 ]—due to alleviating the severity of AF symptomatology and improving recurrence-free survival [ 47 , 48 ]. A multidisciplinary approach should be employed in relation to AF management, incorporating its three traditional pillars (anticoagulation, rhythm control, and rate control) along with a comprehensive risk factor control, which can—among others—be achieved through ensuring that individuals maintain a normal BMI/percentage of lean body mass and fitness level [ 46 , 49 , 50 ].…”

The “obesity paradox” in patients with atrial fibrillation: Insights from the Gulf SAFE registry

“…Interestingly, the obesity "paradox" is not only present in AF but also observed in coronary artery disease, HF, hypertension and other non-cardiovascular diseases (37)(38)(39)(40). For instance, in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial with 1,749 patients with HF, both overweight (HR, 0.51; 95% CI, 0.27-0.95) and obesity (HR, 0.64; 95% CI, 0.43-0.98) were associated with reduced risk of all-cause death (41).…”

Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching

“…However, there are also different voices. “Obesity paradox” was used to present that obesity was associated with the reduced risk of all-cause death, and overweight had been associated with significantly reduced risk of AF (HR 0.82, 95%CI = 0.73-0.89, P < 0.001) [ 44 ]. In the current study, neither before nor after PSM, there was no significant difference in the ratios of obesity between AF and non-AF groups.…”