Heart failure & cardiomyopathiesCohort study
Regional fat distribution as a determinant of mortality in populations with left ventricular systolic dysfunction: challenging the obesity paradox
- Prospective cohort study
- community-based
- UK Biobank Imaging Enhancement Programme
Authors' conclusion
In this large imaging-defined cohort of individuals with LV systolic impairment, central adiposity measures, particularly WC and WHR, were more strongly associated with CV mortality than BMI, body fat percentage, or total fat mass.
Study context
- Population
- UK Biobank participants with cardiac magnetic resonance (CMR)-defined left ventricular (LV) systolic impairment (LVEF <50%), without prevalent HF at baseline
- Participants
- 5,615 participants
- Exposure
- Adiposity measures and mortality
- Outcome
- All-cause and CV mortality
- Follow-up
- Median 13.5 years
Main finding
As reported in the abstract
All-cause and CV mortality per 1 SD increase in adiposity measure
Hazard ratio (95% CI)
BMIall-cause mortality
1.19(1.05–1.34)
BMICV mortality
1.37(1.11–1.69)
Per 1 SD increase in adiposity measure, as printed
HR
- Waist circumference (WC) · all-cause mortality
- 1.25
- WC · cardiovascular (CV) mortality
- 1.49
- Waist-to-hip ratio (WHR) · all-cause mortality
- 1.30
- WHR · CV mortality
- 1.52
Observational data: associations, not effects.
Further findings
Incremental discrimination vs body mass index (BMI)-based reference model
- Reference model C-statistic, all-cause mortality
- 0.67
- Reference model C-statistic, CV mortality
- 0.71
- Adding WC and WHR, ΔC all-cause mortality (up to)
- +0.008
- Adding WC and WHR, ΔC CV mortality (up to)
- +0.012
- Body fat percentage and total fat mass did not meaningfully improve discrimination
- WC and WHR improvements modest but statistically significant
Original publication
Regional fat distribution as a determinant of mortality in populations with left ventricular systolic dysfunction: challenging the obesity paradox. Eur J Prev Cardiol. Published 24 June 2026. doi:10.1093/eurjpc/zwag310
Summarised from the published abstract; every number is checked against it