title: Pre-morbid body mass index and mortality after incident heart failure: the ARIC Study.
abstract: 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.
  
  
  OBJECTIVE
  This study sought to evaluate the prognostic impact of pre-morbid obesity in patients with HF.
  
  
  METHODS
  In the ARIC (Atherosclerosis Risk In Communities) 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 (BMI ≥30 kg/m(2)) compared with normal BMI (18.5 to <25 kg/m(2)) with mortality after incident HF.
  
  
  RESULTS
  Among 1,487 patients with incident HF, 35% were overweight and 47% were obese by pre-morbid BMI measured 4.3 ± 3.1 years before HF diagnosis. Over 10-year follow-up after incident HF, 43% of patients died. After adjustment for demographics and comorbidities, being pre-morbidly overweight (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.58 to 0.90; p = 0.004) or obese (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.001) had a protective association with survival compared with normal BMI. The protective effect of overweight and obesity was consistent across subgroups on the basis of a history of cancer, smoking, and diabetes.
  
  
  CONCLUSIONS
  Our results, for the first time, demonstrate that patients who were overweight or obese before HF development have lower mortality after HF diagnosis compared with normal BMI patients. Thus, weight loss due to advanced HF may not completely explain the protective effect of higher BMI in HF patients.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Umair
authors.initials: U
authors.lastname: Khalid
authors.affiliation: Section of Cardiology, University of Alabama, Birmingham, Alabama.
authors.forename: Sameer
authors.initials: S
authors.lastname: Ather
authors.affiliation: Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: School of Public Health, University of Texas, Houston, Texas.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wruck
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: Section of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joe
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: adeswal@bcm.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000368:Aged; D000886:Anthropometry; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011379:Prognosis
keywords: obesity paradox; outcomes; overweight; pre-morbid