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)
Authors' conclusion
In HFrEF patients, a BMI > 27 was not associated with increased mortality, contradicting the "obesity-survival paradox." In fact, patients with ischemic cardiomyopathy and a BMI > 27 may be associated with a higher mortality rate.
Study context
- Population
- Clinically stable and medically optimized heart failure with reduced ejection fraction (HFrEF) patients from the NorthStar study (enrolled 2005–2009), followed until 2023
- Participants
- 1,017 participants
- Exposure
- Body mass index (BMI) >27 vs BMI 24-27 kg/m²
- Outcome
- All-cause mortality
- Follow-up
- Median 8.8 years
Methodological detailsNorthStar substudy, follow-up via Danish nationwide registries, Cox proportional-hazards models adjusted for prognostic factors
- NorthStar substudy
- Follow-up via Danish nationwide registries
- Cox proportional-hazards models adjusted for prognostic factors
Main finding
As reported in the abstract
Hazard ratio
1.11
CI 0.94–1.32
Events by group
BMI >27vs BMI 24-27
HR 1.11 (CI 0.94–1.32)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | BMI 24-27 | HR (CI) | |
|---|---|---|---|
| CV mortality · median follow-up 8.8 yearsBMI > 27vs BMI 24-27 | 37.9% | 1.21 (0.96–1.53) | |
| All-cause mortality, subgroup with ischemic cardiomyopathyBMI > 27vs BMI 24-27Significantly higher mortality with BMI > 27 | 1.31 (1.05–1.64) | ||
| All-cause mortality, subgroup with non-ischemic cardiomyopathyBMI > 27vs BMI 24-27 | 0.86 (0.66–1.12) | ||
| 0.512Hazard ratio (log scale) |
- CV mortality: BMI > 27 39.5%
First worsening heart failure (HF) event · median follow-up 8.8 years
- HR for first worsening HF event (groups not named in the sentence)
- 1.12 [0.93 - 1.33]
Composite of all-cause death or first worsening HF event · median follow-up 8.8 years
- HR for all-cause death or first worsening HF event (groups not named in the sentence)
- 1.09 [0.93 - 1.27]
Original publication
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). Cardiovasc Diabetol. Published 29 January 2026. doi:10.
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