Introduction: Heart failure with preserved ejection fraction (HFpEF) is associated with increased risk of mortality, including sudden cardiac arrest (SCA). Obesity may play a role in the morbidity and mortality associated with HFpEF.
Hypothesis: Obesity is associated with HFpEF in SCA cases.
Methods: Among sudden cardiac arrest (SCA) cases, 2002 - 2015, in an ongoing community-based study in the US Northwest (catchment population ~1 million), we examined the pattern of overweight and obesity in HFpEF and HFrEF. Cases were included if they were age ≥35, had body mass index (BMI; kg/m2) available, and had either HFpEF (defined as clinical history of HF with EF≥50%) or HFrEF (clinical history of HF with EF≤40%). Normal weight was defined as BMI 18-24.9, overweight as 25-29.9, obese as 30-39.9, and extremely obese as ≥40 kg/m2.
Results: Compared to SCA cases with HFrEF (n=237), SCA cases with HFpEF (n=209) had a significantly higher mean body mass index (32.8 ± 10.2 vs. 29.5 ± 8.0, p<0.001) and were more likely to be obese (47% vs. 38%, p=0.045). In both HFrEF and HFpEF cases, obesity was more prevalent in younger cases. In HFrEF cases age 35-59, 57% of cases were obese; in cases 60-74, 47% were obese; and in cases age ≥75, 30% were obese (p<0.001). In HFpEF cases, this pattern was more pronounced, with over 60% of cases ages 35-59 and 60-74 obese (p<0.001). In this group, extreme obesity (BMI≥40) was observed in 37% of HFpEF cases age 35-59 and 30% in age 60-74 (Figure).
Conclusions: Among SCA cases with HFpEF, obesity and extreme obesity were highly prevalent, suggesting that obesity may play a role in SCA with HFpEF, particularly in younger cases.