Being overweight may actually benefit some cardiac patients

By Piriya Mahendra

A high body mass index (BMI) and large waist circumference are associated with improved outcomes in both men and women with heart failure (HF), research shows.

Study findings show that 2-year survival free of the primary outcome (death, urgent heart transplantation, or ventricular assist device placement) was higher in men with elevated BMI (≥25 kg/m²) compared with normal BMI (18.5-24.9 kg/m²), at 63.2% versus 53.5% (p<0.001).

Higher 2-year event-free survival was also seen in women with a high BMI versus a normal BMI, at 67.1% versus 56.6% (p=0.01).

Men with a large waist circumference (≥102 cm) had a greater chance of 2-year event-free survival than those with a normal waist circumference (<102 cm), at 78.8% versus 63.1%, but the rate was similar for women with a large waist circumference and those with a normal one.

However, multivariate analysis revealed that both normal BMI and normal waist circumference were significant predictors for the primary outcome in HF patients.

Indeed, for men, having a normal BMI was associated with a 34% higher risk for the primary outcome than having a high BMI, and for women, the risk associated with a normal BMI was 38% higher.

And in terms of having a normal waist circumference, men were at a twofold higher risk for the primary outcome, while women were at an almost threefold higher risk than those who had a high waist circumference.

Obesity has previously been associated with improved outcomes in HF, a phenomenon dubbed the "obesity paradox." However, until now, it has been unclear whether the paradox relating to BMI and waist circumference applies to both genders.

"To our knowledge, our study is the first to specifically demonstrate that the obesity paradox in terms of BMI and [waist circumference] is applicable to men and women with HF," say lead author Tamara Horwich (University of California, Los Angeles, USA) and team in the American Journal of Cardiology.

They hypothesize that patients with HF may benefit from increased muscle mass and/or increased metabolic reserve in the form of fatty tissue.

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