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Cited by 809Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsObesity, Physical Activity, Diet

The Obesity Paradox: Body Mass Index and Outcomes in Patients With Heart Failure

Curtis, Jeptha P., Selter, Jared G., Wang, Yongfei, Rathore, Saif S., Jovin, Ion S., Jadbabaie, Farid, Kosiborod, Mikhail, Portnay, Edward L. +3 more·2005·Archives of Internal Medicine
DOI 10.1001/archinte.165.1.55
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Abstract

BACKGROUND: In the general population, obesity is associated with increased risk of adverse outcomes. However, studies of patients with chronic disease suggest that overweight and obese patients may paradoxically have better outcomes than lean patients. We sought to examine the association of body mass index (BMI) and outcomes in stable outpatients with heart failure (HF). METHODS: We analyzed data from 7767 patients with stable HF enrolled in the Digitalis Investigation Group trial. Patients were categorized using baseline BMI (calculated as weight in kilograms divided by the square of height in meters) as underweight (BMI <18.5), healthy weight (BMI, 18.5-24.9, overweight (BMI, 25.0-29.9), and obese (BMI > or =30.0). Risks associated with BMI groups were evaluated using multivariable Cox proportional hazards models over a mean follow-up of 37 months. RESULTS: Crude all-cause mortality rates decreased in a near linear fashion across successively higher BMI groups, from 45.0% in the underweight group to 28.4% in the obese group (P for trend <.001). After multivariable adjustment, overweight and obese patients were at lower risk for death (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.80-0.96, and HR, 0.81; 95% CI, 0.72-0.92, respectively), compared with patients at a healthy weight (referent). In contrast, underweight patients with stable HF were at increased risk for death (HR 1.21; 95% CI, 0.95-1.53). CONCLUSIONS: In a cohort of outpatients with established HF, higher BMIs were associated with lower mortality risks; overweight and obese patients had lower risk of death compared with those at a healthy weight. Understanding the mechanisms and impact of the "obesity paradox" in patients with HF is necessary before recommendations are made concerning weight and weight control in this population.

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  • A paradoxical survival advantage with higher BMI exists in the elderly and in a broad range of illnesses, including diabetes mellitus, chronic heart failure, acute heart failure, coronary artery disease, and percutaneous coronary artery interventions.

    “the case is strong that such a paradoxical relation exists in the elderly, 7 and accompanying a broad range of illnesses, including diabetes mellitus, 8 chronic heart failure, 9,10 acute heart failure, 11 coronary artery disease, 12 and percutaneous coronary artery interventions.13”

    From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [9]

  • In another cohort of outpatients with established heart failure, higher BMIs were associated with lower mortality risk.

    “In another cohort of outpatients with established heart failure, higher BMIs were associated with lower mortality risk (65).”

    From Cardiac remodeling in obesity (2008) · cites this paper as [65]

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Authors
Curtis, J. P., Selter, J. G., Wang, Y., Rathore, S. S., Jovin, I. S., Jadbabaie, F., Kosiborod, M., Portnay, E. L., Sokol, S. I., Bader, F., & Krumholz, H. M.
Affiliations
Yale University (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2005-01-10
Volume
165
Issue
1
Pages
55
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.165.1.55
OpenAlex
W2125520495
Cited by
809
References
41
Citations by year
2026: 21 · 2025: 18 · 2024: 15 · 2023: 25 · 2022: 16 · 2021: 35 · 2020: 40 · 2019: 34 · 2018: 32 · 2017: 62 · 2016: 37 · 2015: 41 · 2014: 54 · 2013: 46 · 2012: 50
FWCI
31.22
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
obesity paradox, heart failure, body mass index, overweight, underweight, all-cause mortality, weight management, Digitalis Investigation Group trial, stable outpatients
MeSH terms
Aged, Clinical Trials as Topic, Female, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Obesity, Outpatients, Body Mass Index, Multivariate Analysis, Proportional Hazards Models

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