Body mass index, prognosis and mode of death in chronic heart failure: Results from the Valsartan Heart Failure Trial

Aims: To assess the relationship between body mass index (BMI), mortality and mode of death in chronic heart failure (CHF) patients; to define the shape of the relationship between BMI and mortality. Methods and results: We performed a post-hoc analysis of 5010 patients from the Valsartan Heart Failure Trial. The end-points of the study were all-cause and cardiovascular mortality. Mortality rate was 27.2% in underweight patients (BMI < 22 kg/m²), 21.7% in normal weight patients (BMI 22-24.9 kg/m²), 17.9% in overweight patients (BMI 25-29.9 kg/m²) and 16.5% in obese patients (BMI > 30 kg/m²) (p < 0.0001). The rates of non-cardiovascular death did not differ among groups. The risk of death due to progressive heart failure was 3.4-fold higher in the underweight than in the obese patients (p < 0.0001). Normal weight, overweight and obese patients had lower risk of death as compared with underweight patients (p = 0.019, HR 0.76, 95% CI 0.61-0.96; p = 0.0005, HR 0.68, 95% CI 0.55-0.84; p = 0.003, HR 0.67, 95% CI 0.52-0.88, respectively) independently of symptoms, ventricular function, beta-blocker use, C-reactive protein and brain natriuretic peptide levels. Conclusions: In CHF patients a higher BMI is associated with a better prognosis independently of other clinical variables. The relationship between mortality and BMI is monotonically decreasing.