title: Body mass index, gender, and clinical outcome among hypertensive and diabetic patients with stage A/B heart failure.
abstract: OBJECTIVE
  The existence of an "obesity paradox" in asymptomatic patients with preclinical heart failure (HF) has not been investigated. The prognostic value of BMI in a cohort of hypertensive and diabetic patients with stage A/B HF enrolled in the PROBE-HF study was explored.
  
  
  METHODS
  BMI was measured in 1003 asymptomatic subjects (age 66.4 ± 7.8 years, 48% males) with hypertension and/or type 2 diabetes and no clinical evidence of HF. Predefined endpoints were all-cause mortality and a composite of death and hospitalization for cardiac causes.
  
  
  RESULTS
  During a follow-up of 38.5 ± 4.1 months, 33 deaths were observed. Mortality in the normal BMI group (1.6 deaths per 100 patient-years) did not differ to that in the overweight group (1.1 per 100 patient-years, p = 0.31), but was higher than that in the obese group (0.4 per 100 patient-years, p = 0.0089). In multivariable analysis, obesity (hazard ratio [HR] 0.27 [0.09-0.85], p = 0.025) but not overweight (HR 0.68 [0.32-1.45], p = 0.32) was associated with lower risk of death. Obesity was also independently associated with reduced risk of the composite endpoint (HR 0.54 [0.28-0.99], p = 0.047).
  
  
  CONCLUSIONS
  In asymptomatic hypertensive and diabetic patients with preclinical HF, obesity is associated with better survival and reduced risk of events.
authors.affiliation: Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.forename: Irene
authors.initials: I
authors.lastname: Betti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Castelli
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Alfredo
authors.initials: A
authors.lastname: Zuppiroli
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012306:Risk; D012737:Sex Factors