A so-called ‘obesity paradox’ in heart failure patients is a misinterpretation of data, an expert says today.
Obesity has been repeatedly shown to be an independent risk factor for heart failure but has been linked to improved survival once heart failure has developed.
But the link has generally been based on body mass index which is an imperfect measure of adiposity.
Now Professor John McMurray of the University of Glasgow, UK, and colleagues have taken a closer look.
They write in the European Heart Journal today that: “Newer indices such as the waist-to-height ratio better reflect the location and amount of ectopic fat, as well as the weight of the skeleton.”
So they compared the prognostic value of these tests in patients with heart failure and reduced ejection fraction, an inefficient left ventricle muscle.
The team found that an ‘obesity-survival paradox’ was apparent, but disappeared once waist-to-height ratio was taken into account.
Ultimately, both greater body mass index and waist-to-height ratio were linked to a
higher risk of hospitalisation or death due to heart failure.
They write: “Newer indices that do not incorporate weight showed that greater adiposity was clearly associated with a higher risk of heart failure hospitalisation.”
Commenting on the findings, Professor Stephan von Haehling of the University of Gottingen Medical Centre in Germany, and colleagues state: “The present findings raise the alarm over the term ‘obesity paradox’.”
They call for more studies on patients with heart failure with preserved ejection fraction, and in healthy weight and underweight patients.
“Further tests are warranted to validate the effect of weight loss in ‘truly’ obese heart failure patients with a high waist to height ratio,” they write.
Butt, J. H. et al. Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox. European Heart Journal 22 March 2023; doi:10.1093/eurheartj/ehad083
Sato, R. et al. Revisiting the obesity paradox in heart failure: what is the best anthropometric index to gauge obesity? European Heart Journal 22 March 2023 doi: 10.1093/eurheartj/ehad079.
Leave a Reply