Heart failure & cardiomyopathiesSecondary analysis
Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial
- Secondary analysis of the PARAGON-HF randomised trial
Authors' conclusion
In PARAGON-HF, in contrast with BMI, nearly every patient with HFpEF had central adiposity (as assessed by WHtR), and the risks of adverse HF events were more robustly related to WHtR.
Study context
- Population
- Patients with heart failure (HF) and EF ≥45% (heart failure and preserved ejection fraction (HFpEF))
- Participants
- 4,796 patients
- Comparison
- Body mass index (BMI) vs waist-to-height ratio (WHtR) as adiposity metrics
Primary result
As reported in the abstract
Prevalence of obesity and central adiposity
Obese by BMI (≥30 kg/m²)
49%
Central adiposity (WHtR ≥.5)
96%
Marked central adiposity (WHtR ≥.6) among non-obese (BMI <30 kg/m²)
860 (37%)
Further findings
HF outcomes by BMI and WHtR
- Higher BMI and WHtR both associated with higher risk of total HF hospitalizations; WHtR linearly associated with HF outcomes and identified more patients at particularly elevated risk (30% or greater)
- Obesity-survival paradox apparent with BMI in unadjusted analyses, not observed with WHtR
Response to neprilysin inhibition by adiposity
- Greater apparent effects on HF outcomes with higher BMI and WHtR, but no significant heterogeneity across adiposity values
Original publication
Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial. Eur Heart J. Published 28 January 2025. doi:10.1093/eurheartj/ehaf057
Summarised from the published abstract; every number is checked against it