ABSTRACT
AIMS: Obesity and diabetes are associated with an increased cardiovascular risk and mortality. Paradoxically, higher BMI is associated with longer survival in heart failure patients. The association between BMI and risk of death in heart failure patients depends on diabetes history. METHODS: We conducted a retrospective cohort study on 503 ambulatory systolic heart failure patients attending a heart failure clinic, based on abstraction of data from clinical records. Patients were compared according to diabetes history. BMI was analyzed as a continuous variable and dichotomized using 25âkg/m as cut-off. Patients' follow-up was censored at 5 years and all-cause death was the endpoint under study. RESULTS: The median age was 69 years and 68% were men; 184 (36.6%) patients had diabetes upon referral. During follow-up, 95 nondiabetic and 69 diabetic patients died. Higher BMI was associated with longer survival in the whole sample, but this association was only reproduced in the subgroup of patients without diabetes [hazard ratioâ=â0.93; 95% confidence interval (CI): 0.89-0.98 per kg/m vs. hazard ratioâ=â0.99; 95% CI: 0.94-1.04 in diabetic patients; P for interactionâ=â0.009]. BMI below 25âkg/m increased the risk of death by 1.90-fold (95% CI: 1.23-2.94) with a null association in diabetic patients (P for interactionâ=â0.012). The association between BMI and mortality in nondiabetic heart failure patients was independent of other predictors of prognosis. CONCLUSION: The reported obesity paradox in heart failure can only be observed in nondiabetic patients.