Peak oxygen consumption as a modifier of the obesity paradox in patients with obesity with heart failure with reduced ejection fraction
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.46 95% CI 0.25–0.82Authors' conclusion
Patients with obesity and HFrEF showed better survival, consistent with the obesity paradox. However, the U-shaped relationship between peak VO2 and mortality in this group suggests the survival advantage may diminish at higher levels of exercise capacity, warranting further investigation.
Study context
- Population
- Patients with HF with reduced ejection fraction (HFrEF) (LVEF <40%, body mass index (BMI) >18.5 kg/m²) undergoing maximal cardiopulmonary exercise testing, 2012–2020; median age 59 years, 75.2% male18,879 screened
- Participants
- 819 patients
- Exposure
- Obesity vs overweight vs normal weight
- Normal weightn = 292reference
- Overweightn = 197
- Obesityn = 330
- Outcome
- All-cause mortality
Main finding
As reported in the abstract
Hazard ratio
0.46
95% CI 0.25–0.82
P = 0.009
Obesityvs Normal weight
HR 0.46 (95% CI 0.25–0.82); P = 0.009
Observational data: associations, not effects.
Further findings
Peak VO2 and mortality by BMI category
- In obesity, elevated peak VO2 associated with U-shaped mortality curve vs linear relationship in other groups
- P for interaction = 0.001
Workload, peak VO2 and exercise time
- Obesity achieved the highest workload, peak VO2 and exercise time
- all P < 0.001
Original publication
Peak oxygen consumption as a modifier of the obesity paradox in patients with obesity with heart failure with reduced ejection fraction. Int J Obes (Lond). Published 2 February 2026. doi:10.
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