Long-Term Impact of Clinical Obesity on Heart Failure Development and Prognosis

BACKGROUND: The Lancet Diabetes & Endocrinology Commission recognizes clinical obesity as an independent disease, although its link to heart failure (HF) remains underexplored. OBJECTIVES: The goal of this study was to evaluate the impact of clinical obesity on new-onset HF risk and subsequent all-cause mortality after the development of HF. METHODS: Clinical obesity was defined based on body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, and 10 clinical criteria. A total of 99,131 participants from the Kailuan Study cohort were classified into nonobese, preclinical obesity, and clinical obesity groups. A Cox proportional hazards model was applied to assess the association between clinical obesity and the risk of new-onset HF, and all-cause mortality was examined among those with HF. RESULTS: Over a median follow-up of 16.0 years, 3,280 participants developed HF, and there were 19,170 deaths from any cause. Compared with the nonobese group, clinical obesity was associated with a 63% higher risk of new-onset HF (adjusted [aHR]: 1.63; 95% CI: 1.49-1.77), with varying risks across HF subtypes. Within the clinical obesity group, HF risk increased with the number of clinical criteria: one (aHR: 1.50; 95% CI: 1.37-1.64), two (aHR: 1.91; 95% CI: 1.70-2.14), and three or more (aHR: 2.20; 95% CI: 1.80-2.68). However, clinical obesity was not associated with increased all-cause mortality after HF (aHR: 1.01; 95% CI: 0.90-1.15). CONCLUSIONS: These findings highlight clinical obesity as a risk factor for new-onset HF and all-cause mortality, driven both by excess weight and associated clinical conditions. Recognizing clinical obesity as an independent disease may support more effective HF prevention strategies.