Obesity is considered as an independent risk factor for development of heart failure (HF); however, its role in the progression of HF independent of atherosclerotic heart disease, hypertension, and diabetes is not well described.

To identify the role of obesity in HF outcomes, we analyzed the Digitalis Investigation Group database with 7788 patients with chronic stable HF. Subjects with body mass index of ≥18.5 and <25 kg/m² were categorized as normal weight, ≥25.0 and <30 kg/m² as overweight, and ≥30.0 kg/m² as obese.

Compared with normal weight, overweight or obese patients had lower all-cause mortality (37.8%, 32.4%, and 28.5%, P < .0001) and lower HF mortality (38.7%, 31.2%, and 33.6%, P = .01). After adjustment for differences in baseline characteristics, the overweight (HR 0.87, 95% CI 0.79-0.95, P = .002) and the obese (HR 0.82, 95% CI 0.73-0.92, P = .0005) had better survival rates compared with normal-weight groups. Similarly, the overweight (HR 0.76, 95% CI 0.65-0.88, P = .0003) or the obese (HR 0.79, 95% CI 0.63-0.88, P = .005) patients had better HF survival rates. After adjustment for baseline differences, the rate of hospitalizations was similar in the 3 groups.

In patients with chronic symptomatic HF, obesity or overweight status was associated with a lower risk for mortality but a similar risk for hospitalization compared with normal weight status. Prospective studies evaluating the risks and benefits of sustenance of obesity or weight loss are needed in this population.