title: BMI is inversely correlated to the risk of mortality in patients with type 2 diabetes hospitalized for acute heart failure: Findings from the Gulf aCute heArt failuRE (Gulf-CARE) registry.
abstract: BACKGROUND
  A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF.
  
  
  METHODS
  We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m2), normal weight (referent group, 20-24.9kg/m2), overweight, (25-29.9kg/m2), obese (30-34.9kg/m2) and severely obese (≥35kg/m2), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE).
  
  
  RESULTS
  Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obese patients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively).
  
  
  CONCLUSIONS
  In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
authors.affiliation: Department of Medicine, Weill Cornell Medicine, Doha, Qatar; Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar; Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. Electronic address: cha2022@med.cornell.edu.
authors.forename: Charbel
authors.initials: C
authors.lastname: Abi Khalil
authors.affiliation: National Heart Center, Royal Hospital, Muscat, Oman.
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.affiliation: Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Endocrinology and Diabetes, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Amin
authors.initials: A
authors.lastname: Jayyousi
authors.affiliation: Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Nidal
authors.initials: N
authors.lastname: Asaad
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: College of Medicine, Mohammed Bin Rashid University of Medicine and Heath Sciences Dubai, United Arab Emirates.
authors.forename: Alawi
authors.initials: A
authors.lastname: Alsheikh-Ali
authors.affiliation: Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Jarallah
authors.affiliation: Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Bassam
authors.initials: B
authors.lastname: Bulbanat
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE.
authors.forename: Wael
authors.initials: W
authors.lastname: AlMahmeed
authors.affiliation: Department of Cardiology, Adan Hospital, Kuwait.
authors.forename: Soha
authors.initials: S
authors.lastname: Dargham
authors.affiliation: Department of Epidemiology and Global Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ridha
authors.affiliation: Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates.
authors.forename: Nooshin
authors.initials: N
authors.lastname: Bazargani
authors.affiliation: Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain.
authors.forename: Haitham
authors.initials: H
authors.lastname: Amin
authors.affiliation: Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Motarreb
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Husam
authors.initials: H
authors.lastname: AlFaleh
authors.affiliation: Cardiology Department, Tanta University, Tanta, Egypt.
authors.forename: Abdelfatah
authors.initials: A
authors.lastname: Elasfar
authors.affiliation: National Heart Center, Royal Hospital, Muscat, Oman.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Panduranga
authors.affiliation: Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D000208:Acute Disease; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
keywords: BMI; Cardiovascular mortality; Diabetes; Heart failure