Association of Body Mass Index with ten-year outcomes in asymptomatic Stage A/B heart failure patients: Insights from the CHART-2 study

The progressive nature of heart failure (HF) is influenced by underlying pathophysiological mechanisms, including nutrition and metabolism. Previous studies have highlighted the prognostic importance of body mass index (BMI) in patients with stage C/D HF patients; however, limited data exist on the asymptomatic HF stages (stage A/B) METHODS: We prospectively evaluated consecutive HF patients in stage A/B (n = 501/4767, respectively, mean age 67.6 ± 12.0 years, male 71.1 %) from the multicenter observational CHART-2 (chronic HF registry and analysis in the Tohoku District-2) study. Patients were stratified into four groups based on BMI (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m²) according to the WHO criteria. We assessed 10-year survival and hospitalization rates, using a composite endpoint of all-cause death or HF hospitalization RESULTS: The lowest BMI (<18.5 kg/m²) was significantly associated with the composite endpoints and the incidence of HF (both P < 0.05). This association was particularly pronounced in older patients (above median age: 70 years), but was not evident in younger patients (below median age). Additionally, the lowest BMI group was characterized by older age and lower albumin levels (P < 0.05). There were variations in the correlation between BMI and composite endpoints among age groups; in the elderly, a lower BMI was consistently associated with worse prognosis; in younger patients, the association was not evident CONCLUSION: These results provide the first evidence that a lower BMI significantly impacts all-cause death or HF hospitalization in the older population, even in the early stages preceding HF.