Abdominal obesity linked to greater all-cause mortality in HFpEF patients

Cardiac patients diagnosed with heart failure with preserved ejection fraction (HFpEF) are significantly more prone to both cardiovascular and all-cause mortality if they also have abdominal obesity, according to research published this week in the Journal of the American College of Cardiology.

HFpEF accounts for around half of all cases of heart failure, study authors Hiroshi Kajio, MD, PhD, and Tetsuro Tsujimoto, MD, PhD, wrote, but the condition isn’t well-comprehended in the medical community and effective treatment strategies are still lacking. Though rates of hospitalization and all-cause mortality in patients with HFpEF are similar to those in patients with heart failure with reduced ejection fraction (HFrEF), the latter illness has gained more momentum as a study subject.

Clinical trials testing treatments that have proven successful in HFrEF patients failed to produce the same results in patients living with HFpEF, the authors said, suggesting an urgent need for innovative, effective treatments for the disease.

“The fundamental pathophysiology of HFpEF is complex and poorly understood,” Kajio and Tsujimoto wrote, noting that no clinical guidelines offering recommendations for the management of HFpEF currently exist, even though its presence continues to grow.

The authors pulled data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial for their evaluation. They included 3,310 patients with HFpEF in their study—2,413 of whom were diagnosed with abdominal obesity—and followed the subjects for an average of three years. Abdominal obesity was defined as a waist circumference of 102 centimeters or greater in men and 88 centimeters or greater in women, according to the study, and the trial’s primary outcome was all-cause mortality.

Kajio and Tsujimoto found all-cause mortality rates in patients with and without abdominal obesity were 46.1 and 40.7 events per 1,000 person-years, respectively. After adjustment for multiple variables, it was clear to the researchers that HFpEF patients with abdominal obesity saw significantly higher risks of mortality than those without it.

Compared with patients without abdominal obesity, those with the condition were more likely to be women, black, have never smoked and have a lower alcohol intake, according to the research. Obese individuals were also more likely to have diabetes, hypertension, dyslipidemia, myocardial infarction, atrial fibrillation and a slew of other heart-related illnesses.

“The findings of the present study demonstrated that abdominal obesity in patients with HFpEF is significantly associated with higher risks of all-cause, cardiovascular and noncardiovascular mortality,” the authors wrote. “The association between abdominal obesity and increased mortality was also observed in various clinically important subgroups. Further studies are required to elucidate the detailed mechanisms underlying the association between abdominal obesity and adverse outcomes in patients with HFpEF.”