Mixed
The adverse association between elevated BMI (>27 kg/m²) and mortality in HFrEF patients is significantly stronger in those with ischemic cardiomyopathy compared to non-ischemic cardiomyopathy.
If your heart failure is caused by coronary artery disease (ischemic), keeping your BMI under 27 is particularly important for your survival. In patients with non-ischemic heart failure, the link between higher BMI and death was not statistically significant in this study, suggesting that weight management strategies might need to be tailored to your specific heart condition.
Subgroup analysis showed higher mortality with BMI >27 vs. 24–27 in ischemic cardiomyopathy (HR 1.31, 95% CI 1.05–1.64), but not in non-ischemic (HR 0.86, 95% CI 0.66–1.12), interaction p=0.015.
Why this rating
Statistically significant interaction (p=0.015) in a large, well-characterized cohort.
Source
Associations of Body Mass Index on worsening of heart failure and mortality in patients with heart failure and reduced left ventricular ejection fraction: A 10-year follow-up study (A NorthStar Substudy)
Morten Malmborg et al. · medRxiv · 2025
DOI 10.1101/2025.05.05.25327040
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