BMI is inversely correlated to the risk of mortality in patients with type 2 diabetes hospitalized for acute heart failure: Findings from the Gulf aCute heArt failuRE (Gulf-CARE) registry.
BACKGROUND
A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF.


METHODS
We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m2), normal weight (referent group, 20-24.9kg/m2), overweight, (25-29.9kg/m2), obese (30-34.9kg/m2) and severely obese (≥35kg/m2), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE).


RESULTS
Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obese patients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively).


CONCLUSIONS
In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
['Abi Khalil|Charbel|C|', 'Sulaiman|Kadhim|K|', 'Singh|Rajvir|R|', 'Jayyousi|Amin|A|', 'Asaad|Nidal|N|', 'AlHabib|Khalid F|KF|', 'Alsheikh-Ali|Alawi|A|', 'Al-Jarallah|Mohammed|M|', 'Bulbanat|Bassam|B|', 'AlMahmeed|Wael|W|', 'Dargham|Soha|S|', 'Ridha|Mustafa|M|', 'Bazargani|Nooshin|N|', 'Amin|Haitham|H|', 'Al-Motarreb|Ahmed|A|', 'AlFaleh|Husam|H|', 'Elasfar|Abdelfatah|A|', 'Panduranga|Prashanth|P|', 'Al Suwaidi|Jassim|J|']
D000208:Acute Disease D000368:Aged D015992:Body Mass Index D003924:Diabetes Mellitus, Type 2 D005260:Female D006333:Heart Failure D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D008877:Middle East D009026:Mortality D011446:Prospective Studies D012042:Registries D012307:Risk Factors
BMI Diabetes Heart failure Cardiovascular mortality