Premorbid Body-Mass Index and Mortality after Incident Heart Failure: The Atherosclerosis Risk in Communities Study

BACKGROUND— Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding. OBJECTIVES— We sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF. METHODS— In the Atherosclerosis Risk in Communities (ARIC) study, we used body mass index (BMI) measured ≥6 months before incident HF (pre-morbid BMI) to evaluate the association of overweight (BMI 25 to <30 kg/m 2 ) and obesity (≥30 kg/m 2 ) compared to normal BMI (18.5 to <25 kg/m 2 ) with mortality after incident HF. RESULTS— Among 1,487 0.004) or obese (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared to normal BMI. The protective effect of overweight and obesity was consistent across subgroups based on a history of cancer, smoking, and diabetes. CONCLUSIONS— Our results, for the first time, demonstrate that individuals who were overweight or obese before HF development have lower mortality once they have HF compared with normal BMI individuals. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.