THE OBESITY PARADOX IN HEART FAILURE: TIME TO MOVE FORWARD

Obesity is a risk factor for incident heart failure (HF), linked to, but also independent of, coexisting comorbidities. The association of obesity is stronger for HF with preserved versus reduced ejection fraction. Further, obesity is associated with a higher risk of HF hospitalization in patients with HF. However, multiple studies in patients with prevalent HF have suggested that higher body mass index (BMI) is associated with lower mortality-the "obesity survival paradox." This paradox was also observed with preexisting obesity prior to the development of HF. These observations had complicated the case for the routine recommendation of weight loss in patients with obesity and HF. However, recent trials with anti-obesity medications are leading to a better understanding of the benefits of weight loss in HF and thus support a reevaluation of the obesity survival paradox in HF.