title: Obesity paradox and risk of sudden death in heart failure results from the MUerte Subita en Insuficiencia cardiaca (MUSIC) study.
abstract: BACKGROUND
  among patients with heart failure (HF), body mass index (BMI) has been inversely associated with mortality, giving rise to the so-called obesity paradox. The aim of this study was to examine the relationship between BMI and two modes of cardiac death: pump failure death and sudden death.
  
  
  METHODS
  nine hundred seventy-nine patients with mild to moderate chronic symptomatic HF from the MUSIC (MUerte Subita en Insuficiencia Cardiaca) Study, a prospective, multicenter, and longitudinal study designed to assess risk predictors of cardiac mortality, were followed up during a median of 44 months. Independent predictors of death were identified by a multivariable Cox proportional hazards model.
  
  
  RESULTS
  higher BMI emerged as an independent predictor of all-cause mortality (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.91-0.97, P = .0003) and pump failure death (HR = 0.93, 95% CI = 0.88-0.98, P = .004). Sudden death accounted for 45% of deaths in obese patients, 53% in overweight patients, and 37% in lean patients. No significant relationship between BMI and sudden death was observed (HR = 0.97, 95% CI = 0.92-1.02, P = .28). The only independent predictors of sudden death were prior history of myocardial infarction (HR = 1.89, 95% CI = 1.23-2.90, P = .004), hypertension (HR = 1.66, 95% CI = 1.05-2.63, P = .03), left ventricular ejection fraction (HR = 0.88, 95% CI = 0.79-0.96, P = .006), and N-terminal pro-B-type natriuretic peptide (HR = 1.01, 95% CI = 1.00-1.02, P = .048).
  
  
  CONCLUSIONS
  the obesity paradox in HF affects all-cause mortality and pump failure death but not sudden death. The risk of dying suddenly was similar across BMI categories in this cohort of ambulatory patients with HF.
authors.affiliation: ICREC Research Group, Health Science Research Institute, Germans Trias i Pujol, Badalona, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gastelurrutia
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.forename: Rafael
authors.initials: R
authors.lastname: Vazquez
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Lillian Grigorian
authors.initials: LG
authors.lastname: Shamagian
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Antoni Bayes
authors.initials: AB
authors.lastname: de Luna
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D055815:Young Adult