Secondary analysis
Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox
- Secondary analysis of the PARADIGM-HF randomised trial
Authors' conclusion
In patients with HFrEF, alternative anthropometric measurements showed no evidence for an 'obesity-survival paradox'. Newer indices that do not incorporate weight showed that greater adiposity was clearly associated with a higher risk of HF hospitalization.
Study context
- Population
- Patients with HFrEF enrolled in a trial comparing ARNI with ACEi
- Comparison
- Newer anthropometric indices vs body mass index (BMI)
- Primary endpoint
- Heart failure (HF) hospitalization or CV death
Primary result
As reported in the abstract
Primary outcome (HF hospitalization or CV death) by adiposity
- Greater adiposity (BMI and waist-to-height ratio) associated with higher risk of the primary outcome; more evident for waist-to-height ratio and persisted after adjustment
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| HF hospitalization, waist-to-height ratio | 1.39 (1.06–1.81) | |
| All-cause mortality, waist-to-height ratio | 1.10 (0.87–1.39) | |
| 0.512Adjusted hazard ratio (log scale) |
All-cause mortality, BMI ≥25 kg/m² vs normal weight
- 'Obesity-survival paradox' (lower mortality risk with BMI ≥25 kg/m²) identified but eliminated by adjustment for other prognostic variables
Original publication
Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox. Eur Heart J. Published 22 March 2023. doi:10.1093/eurheartj/ehad083
Summarised from the published abstract; every number is checked against it