This is not the first study to describe a protective effect for obesity in heart failure patients, senior author Dr. Harlan M. Krumholz and colleagues, from Yale University School of Medicine in New Haven, Connecticut, note. However, past studies were typically small in size and focused on patients with severe heart failure, mostly ignoring the larger population of outpatients with preserved systolic function.

The current study, which is reported in the January 10th issue of the Archives of Internal Medicine, involved 7767 patients with stable heart failure who were enrolled in the Digitalis Investigation Group trial. Using standard BMI definitions, the patients were divided into four groups: underweight, healthy weight, overweight and obese. The mean follow-up period was 37 months.

All-cause mortality fell as the reference group moved from underweight --45% -- to obese -- 28.4% (p < 0.001 for trend). On multivariate analysis, obese and overweight patients were 19% and 12% less likely to die, respectively, than healthy weight patients. By contrast, underweight patients were 21% more likely to die than their healthy weight peers.

As to why obesity is linked to better outcomes in heart failure patients, the authors speculate it may be because weight-related problems cause them to be diagnosed at an earlier stage. Also, it could be related to the absence of cachexia, a condition of significant weight loss often seen with advanced heart failure.

So what does this mean for clinicians treating overweight or obese heart failure patients? Until further data are available, the findings suggest that they should resist advising overweight or obese heart failure patients to lose weight , the report states.

Source: Diabetes In Control.com: Arch Intern Med 2005;165:55-61.