Heart failure & cardiomyopathiesMeta-analysis
Adiposity-Related Anthropometrics and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction
- Participant-level pooled analysis of 5 randomised trials
- international
Authors' conclusion
These data from 5 large-scale HFmrEF/HFpEF clinical trials further question the utility of BMI as the sole measure to define obesity. WC or WHtR assessment identifies a substantial number of individuals with abdominal obesity despite BMI <30 kg/m2, and may enhance risk stratification beyond BMI alone in HFmrEF/HFpEF.
Study context
- Population
- Adults with heart failure with mildly reduced ejection fraction (HFmrEF)/heart failure with preserved ejection fraction (HFpEF)WC and WHtR in 7,827
- Participants
- 21,479 adults
- Comparison
- Adiposity-related anthropometrics and heart failure (HF) and mortality outcomes
Pooled result
As reported in the abstract
Association of adiposity-related anthropometrics (BMI, WHtR) with HF and mortality outcomes
- BMI showed complex J- and U-shaped associations with clinical outcomes
- Higher WHtR linearly associated with increased risk of HF and mortality events
- Independent of BMI, higher WHtR associated with adverse outcomes
- Independent of WHtR, higher BMI associated with HF hospitalization
- Elevated BMI and WHtR: higher rates of CV death or HF hospitalization vs elevated BMI or WHtR alone
Further pooled results
Adiposity prevalence at baseline
- BMI ≥30 kg/m²
- 46%
- Elevated WC or WHtR
- 95%
- Excess abdominal adiposity among BMI <30 kg/m² (especially older and female)
- 89%
Modifiers of the BMI–WHtR association
- Sex: women vs men had higher WHtR at higher BMI
- P for interaction = 0.003
- Race: Asian and Black participants had higher WHtR at lower BMI
- P for interaction = 0.046
CV death or HF hospitalization, by age
- Younger participants had steepest associations of BMI or WHtR with outcome
- P for interaction < 0.001
- interaction P <0.001 for both
Original publication
Adiposity-Related Anthropometrics and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol. Published 27 August 2025. doi:10.1016/j.jacc.2025.08.012
Summarised from the published abstract; every number is checked against it