Yu Zeshui, Chen Yuqing, Miranda Oshin, Qi Meiyuzhen, Zhang Manling, Feng Ning, Ryan Timothy P, Schloot Nanette Cathrin, Chen Yu, Sam Flora, Wang Lirong
Department of Pharmaceutical Sciences University of Pittsburgh, School of Pharmacy Pittsburgh PA USA.
Department of Epidemiology Graduate School of Public Health, University of Pittsburgh Pittsburgh PA USA.
J Am Heart Assoc. 2025 Sep 16;14(18):e039976. doi: 10.1161/JAHA.124.039976. Epub 2025 Sep 11.
Body mass index (BMI) variability is a risk factor for various adverse cardiovascular outcomes. However, the specific associations between BMI variability and the risk of developing heart failure with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF), particularly across multiple weight change trends, remain unexplored.
This retrospective cohort study analyzed electronic health records from a sample of patients with overweight or obesity. BMI variability was assessed over a 5-year period using average successive variability, with patients categorized into 3 groups: weight loss, stable weight, and weight gain. We subsequently followed 50 812 eligible patients 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 4.52 years, 2128 patients developed HFpEF and 1121 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 average successive variability of BMI were 1.37 (95% CI, 1.17-1.59) in the weight loss group and 1.24 (95% CI, 1.11-1.40) 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 with those below the median, with the corresponding HRs being 1.47 (95% CI, 1.21-1.79) for the weight loss group and 1.20 (95% CI, 1.06-1.35) for the stable weight group. Among patients who experienced weight gain, BMI variability was not significantly associated with the risk of incident HFpEF or HFrEF (HR, 1.16 [95% CI, 0.88-1.53]; modeled as a continuous variable).
In this large cohort of individuals living with overweight or obesity, greater variability in BMI was significantly associated with a higher risk of developing HFpEF among those with reduced or stable weight.
体重指数（BMI）变异性是多种不良心血管结局的危险因素。然而，BMI变异性与射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）发生风险之间的具体关联，尤其是在多种体重变化趋势方面，仍未得到探索。
这项回顾性队列研究分析了超重或肥胖患者样本的电子健康记录。使用平均连续变异性在5年期间评估BMI变异性，患者被分为3组：体重减轻、体重稳定和体重增加。随后，我们对50812名符合条件的患者进行随访，以监测HFpEF和HFrEF的发病率。应用Cox回归模型来检验BMI变异性与HFpEF和HFrEF风险之间的差异关联。
在中位随访4.52年期间，2128名患者发生了HFpEF，1121名患者发生了HFrEF。在调整相关混杂因素后，BMI变异性升高与HFpEF风险增加相关。在体重减轻组中，BMI平均连续变异性每增加1个标准差，HFpEF的风险比（HR）为1.37（95%CI，1.17-1.59）；在体重稳定组中为1.24（95%CI，1.11-1.40）。此外，当作为除以中位数的二元变量进行分析时，与中位数以下相比，中位数以上的BMI变异性与HFpEF的较高风险相关，体重减轻组相应的HR为1.47（95%CI，1.21-1.79），体重稳定组为1.20（95%CI，1.06-1.35）。在体重增加的患者中，BMI变异性与HFpEF或HFrEF的发病风险无显著关联（HR，1.16[95%CI，0.88-1.53]；作为连续变量建模）。
在这个大量超重或肥胖个体队列中，体重减轻或稳定的人群中，BMI变异性越大与发生HFpEF的风险越高显著相关。
