Clinical, demographic, and laboratory characteristics of 2,323 patients hospitalized with a diagnosis of acute or decompensated chronic HF in 25 public Israeli hospitals between March 1 and April 30, 2003, were categorized by BMI as: normal weight (18.5-24.9 kg/m2; n?= 837), overweight (25.0-29.9 kg/m2; n?= 877), or obese (?0.0 kg/m2; n?= 574), excluding 35 patients with BMI <18.5?kg/m2. Survival over 15 months was inversely related to BMI category. Age-adjusted mortality hazard ratio (HR) was 0.95 (95 % confidence interval [CI] 0.79-1.14) for overweight patients and 0.70 (95 % CI 0.55-0.88) for obese patients compared with normal-weight patients. After further adjustment for gender, ejection fraction, New York Heart Association functional class, ischemic heart disease, diabetes, hypertension, dyslipidemia, renal function, and medications (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, ¦Â-blocker, spironolactone), obesity was associated with a nonsignificant HR of 0.79 (95 % CI 0.59-1.05). Hypertension and dyslipidemia were also paradoxically associated with better survival in our model (HR 0.74, CI 0.59-0.92; and HR 0.77, CI 0.63-0.94; respectively; both P < .05).
Our study falls in line with the obesity paradox observation (in obese but not overweight patients) in a large survey of HF patients, although this finding was not statistically significant on multivariate adjustment analysis.