BMI vs Waist-to-Hip Ratio Impact on Heart Failure

In a new study, increased waist-to-hip ratio was shown to have a significant link to risk of death in heart failure. 

Reference: Streng KW, Voors AA, Hillege HL, et al. Waist-to-hip ratio and mortality in heart failure. Eur J Heart Fail. 2018. 

In patients with chronic heart failure (HF), mild-to-moderate obesity-as measured by body mass index (BMI)-is associated with improved survival. Positing that BMI does not account for body composition, authors of a new study analyzed the association between abdominal fat, measured via waist-to-hip ratio, BMI, and all-cause mortality in patients with established HF. For study highlights and results, click through the slides above.

BMI vs Waist-to-Hip Ratio in Heart Failure. Higher BMI is associated with better survival in HF, however, BMI does not account for body composition. Study explored the association between WHR, BMI and all-cause mortality in HF. 

Scottish BIOSTAT-CHF Study. In the multicenter, prospective observational study, authors evaluated WHR, BMI, 92 cardiovascular markers, and all-cause mortality. 

Increased WHR Linked to Higher Mortality in Women with HF. Study found survival probability significantly higher in obese women and men vs nonobese participants. In women, higher WHR was associated with increased mortality risk vs men who had no significant link between high WHR and mortality risk. 

Clinical Implications. Study results suggest central adiposity may be harmful in HF and may need to be targeted for therapy, especially in women. MAPK cascade shown to be involved in cardiac remodeling and vascular disease and inflammation-associated worse outcomes in HF. 

Take Home Points:

  • First study to show a significant link between increased WHR and risk of death in HF; challenges the obesity paradox about higher BMI and improved HF survival. 
  • Increase WHR in women, but not men was associated with worse HF survival. 
  • Fat distribution may need to be targeted for therapy in HF, especially in women. 
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