The Association of Long-Term Body Mass Index Variability with the Development of HFpEF and HFrEF Across Patterns of Weight Change

BackgroundRecent studies have shown BMI variability is risk factor for various adverse cardiovascular outcomes. However, the specific associations between BMI variability and the risk of developing HFpEF versus HFrEF, particularly across multiple weight change trends, remain unexplored. Methods and ResultsWe identified a cohort of 52,286 eligible patients with overweight or obesity grouped into three categories based on their BMI change patterns over five years: weight loss, stable weight, and weight gain. BMI variability was assessed in the same 5-year period using average successive variability (ASV). These patients were subsequently followed to monitor the incidence of HFpEF and HFrEF. Cox regression models were applied to examine the differential association between BMI variability and HFpEF and HFrEF risk. Over a median follow-up of 4.81 years, 2,295 patients developed HFpEF, and 1,189 developed HFrEF. After adjusting for relevant confounders, elevated BMI variability was associated with an increased risk of HFpEF. The hazard ratios (HRs) of HFpEF for each 1-SD increment in ASV of BMI were 1.27 (95% CI, 1.10-1.47) in the weight loss group and 1.22 (95% CI, 1.09-1.37) in the stable weight group. Additionally, when analyzed as a binary variable divided by the median, BMI variability above the median was associated with higher risks of HFpEF compared to those below the median, with the corresponding HRs being 1.46 (95% CI, 1.20-1.77) for the weight loss group and 1.17 (95% CI, 1.04-1.31) for the stable weight group. ConclusionsIn this large cohort of patients living with overweight or obesity, greater BMI variability was significantly associated with a higher risk of developing HFpEF compared to patients with reduced and stable weight over time. Clinical Perspective Whats new?1. In patients with weight loss and stable weight, those with higher BMI variability have an increased risk of developing incident HFrEF compared to those experiencing lower BMI variability, after adjusting all potential confounding variables. 2. In patients with weight gain, BMI variability was not significantly linked to the risk of developing HFpEF or HFrEF. However, a larger increase in delta BMI was significantly associated with a higher risk of incident HFpEF and HFrEF in this group. What are the clinical implications?1. Promoting the importance of stable and consistent weight management strategies to reduce heart failure risk, particularly by minimizing BMI variability in patients undergoing weight loss or maintaining stable weight.