Skip to content
2000
Volume 32, Issue 16
  • ISSN: 0929-8673
  • E-ISSN: 1875-533X

Abstract

Introduction

The association between obesity and atrial fibrillation (AF) incidence in heart failure with preserved ejection fraction (HFpEF) patients is currently unclear. Our analyses and results are based on the whole Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial (placebo and spironolactone).

Methods

A total of 2138 subjects without baseline AF were included in the trial. Kaplan-Meier (K-M) curves and Cox regression with hazard ratios (HRs) and confidence intervals (CIs) were used to assess the incidence of AF with obesity.

Results

Of 2138 HFpEF patients without baseline AF, 1165 were obese (body mass index [BMI]≥30 kg/m2). The K-M curve showed obese patients developed AF more than overweight (25≤ BMI ≤29.9 kg/m2) patients (=0.013), confirmed by multivariable analysis, while there’s no statistical difference between overweight and normal weight (18.5≤ BMI ≤24.9 kg/m2) patients. The occurrence of AF increased by 3% for every kg/m2 increase in BMI (adjusted HR, aHR: 1.03; 95% CI: 1.00-1.06), with a positive linear association ( for nonlinear: 0.145). Obesity was associated with AF incidence (aHR: 1.62; 95% CI: 1.05-2.50) compared with non-obesity (including overweight and normal-weight patients). Abdominal obesity was associated with increased AF incidence (aHR: 1.70; 95% CI: 1.04-2.77), and AF incidence rose by 18% per centimeter in circumference (aHR: 1.18; 95% CI:1.04-1.34).

Conclusion

Obesity and abdominal obesity increase the incidence of AF in HFpEF patients. Further studies need to determine whether there is a difference in AF in response to spironolactone across obese HFpEF pheno groups.

Clinical Trial Registration

URL: https://clinicaltrials.gov. Unique identifier: NCT00094302. Registered on October 15, 2004.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/cmc/10.2174/0929867330666230606100903
2025-01-01
2026-02-20

  • From This Site

    /content/journals/cmc/10.2174/0929867330666230606100903
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Writing Committee Members; ACC/AHA Joint Committee Members2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.J. Am. Coll. Cardiol.2022285e1e167
     [Google Scholar]
  2. ZakeriR. CowieM.R. Heart failure with preserved ejection fraction: controversies, challenges and future directions.Heart2018104537738410.1136/heartjnl‑2016‑31079029305560
     [Google Scholar]
  3. CampbellR.T. JhundP.S. CastagnoD. HawkinsN.M. PetrieM.C. McMurrayJ.J.V. What have we learned about patients with heart failure and preserved ejection fraction from DIG-PEF, CHARM-preserved, and I-PRESERVE?J. Am. Coll. Cardiol.201260232349235610.1016/j.jacc.2012.04.06423141494
     [Google Scholar]
  4. Al-KhatibS.M. BenjaminE.J. AlbertC.M. AlonsoA. ChauhanC. ChenP.S. CurtisA.B. Desvigne-NickensP. HoJ.E. LamC.S.P. LinkM.S. PattonK.K. RedfieldM.M. RienstraM. RosenbergY. SchnabelR. SpertusJ.A. StevensonL.W. HillsM.T. VoorsA.A. CooperL.S. GoA.S. Advancing research on the complex interrelations between atrial fibrillation and heart failure.Circulation2020141231915192610.1161/CIRCULATIONAHA.119.04520432511001
     [Google Scholar]
  5. PackerM. LamC.S.P. LundL.H. RedfieldM.M. Interdependence of atrial fibrillation and heart failure with a preserved ejection fraction reflects a common underlying atrial and ventricular myopathy.Circulation202014114610.1161/CIRCULATIONAHA.119.04299631887078
     [Google Scholar]
  6. Powell-WileyT.M. PoirierP. BurkeL.E. DesprésJ.P. Gordon-LarsenP. LavieC.J. LearS.A. NdumeleC.E. NeelandI.J. SandersP. St-OngeM.P. Obesity and cardiovascular disease: A scientific statement from the american heart association.Circulation202114321e984e101010.1161/CIR.000000000000097333882682
     [Google Scholar]
  7. CarboneS. LavieC.J. ArenaR. Obesity and heart failure: Focus on the obesity paradox.Mayo Clin. Proc.201792226627910.1016/j.mayocp.2016.11.00128109619
     [Google Scholar]
  8. HorwichT.B. FonarowG.C. ClarkA.L. Obesity and the obesity paradox in heart failure.Prog. Cardiovasc. Dis.201861215115610.1016/j.pcad.2018.05.00529852198
     [Google Scholar]
  9. TutorA.W. LavieC.J. KachurS. MilaniR.V. VenturaH.O. Updates on obesity and the obesity paradox in cardiovascular diseases.Prog. Cardiovasc. Dis.2022S0033-0620(22)00134-710.1016/j.pcad.2022.11.01336481212
     [Google Scholar]
  10. MandviwalaT.M. BasraS.S. KhalidU. PickettJ.K. PrzybylowiczR. ShahT. NambiV. ViraniS.S. DeswalA. Obesity and the paradox of mortality and heart failure hospitalization in heart failure with preserved ejection fraction.Int. J. Obes.20204471561156710.1038/s41366‑020‑0563‑132483205
     [Google Scholar]
  11. RaoV.N. ZhaoD. AllisonM.A. GuallarE. SharmaK. CriquiM.H. CushmanM. BlumenthalR.S. MichosE.D. Adiposity and incident heart failure and its subtypes.JACC Heart Fail.2018612999100710.1016/j.jchf.2018.07.00930316935
     [Google Scholar]
  12. HaykowskyM.J. NicklasB.J. BrubakerP.H. HundleyW.G. BrinkleyT.E. UpadhyaB. BectonJ.T. NelsonM.D. ChenH. KitzmanD.W. Regional adipose distribution and its relationship to exercise intolerance in older obese patients who have heart failure with preserved ejection fraction.JACC Heart Fail.20186864064910.1016/j.jchf.2018.06.00230007558
     [Google Scholar]
  13. AdamoM. GardnerR.S. McDonaghT.A. MetraM. The ‘Ten Commandments’ of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur. Heart J.202243644044110.1093/eurheartj/ehab85334922348
     [Google Scholar]
  14. McDonaghT.A. MetraM. AdamoM. GardnerR.S. BaumbachA. BöhmM. BurriH. ButlerJ. ČelutkienėJ. ChioncelO. ClelandJ.G.F. CoatsA.J.S. Crespo-LeiroM.G. FarmakisD. GilardM. HeymansS. HoesA.W. JaarsmaT. JankowskaE.A. LainscakM. LamC.S.P. LyonA.R. McMurrayJ.J.V. MebazaaA. MindhamR. MunerettoC. Francesco PiepoliM. PriceS. RosanoG.M.C. RuschitzkaF. Kathrine SkibelundA. de BoerR.A. Christian SchulzeP. AbdelhamidM. AboyansV. AdamopoulosS. AnkerS.D. ArbeloE. AsteggianoR. BauersachsJ. Bayes-GenisA. BorgerM.A. BudtsW. CikesM. DammanK. DelgadoV. DendaleP. DilaverisP. DrexelH. EzekowitzJ. FalkV. FauchierL. FilippatosG. FraserA. FreyN. GaleC.P. GustafssonF. HarrisJ. IungB. JanssensS. JessupM. KonradiA. KotechaD. LambrinouE. LancellottiP. LandmesserU. LeclercqC. LewisB.S. LeyvaF. LinhartA. LøchenM-L. LundL.H. ManciniD. MasipJ. MilicicD. MuellerC. NefH. NielsenJ-C. NeubeckL. NoutsiasM. PetersenS.E. Sonia PetronioA. PonikowskiP. PrescottE. RakishevaA. RichterD.J. SchlyakhtoE. SeferovicP. SenniM. SitgesM. Sousa-UvaM. TocchettiC.G. TouyzR.M. TschoepeC. WaltenbergerJ. AdamoM. BaumbachA. BöhmM. BurriH. ČelutkienėJ. ChioncelO. ClelandJ.G.F. CoatsA.J.S. Crespo-LeiroM.G. FarmakisD. GardnerR.S. GilardM. HeymansS. HoesA.W. JaarsmaT. JankowskaE.A. LainscakM. LamC.S.P. LyonA.R. McMurrayJ.J.V. MebazaaA. MindhamR. MunerettoC. PiepoliM.F. PriceS. RosanoG.M.C. RuschitzkaF. SkibelundA.K. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur. Heart J.202142363599372610.1093/eurheartj/ehab36834447992
     [Google Scholar]
  15. PittB. PfefferM.A. AssmannS.F. BoineauR. AnandI.S. ClaggettB. ClausellN. DesaiA.S. DiazR. FlegJ.L. GordeevI. HartyB. HeitnerJ.F. KenwoodC.T. LewisE.F. O’MearaE. ProbstfieldJ.L. ShaburishviliT. ShahS.J. SolomonS.D. SweitzerN.K. YangS. McKinlayS.M. InvestigatorsT. Spironolactone for heart failure with preserved ejection fraction.N. Engl. J. Med.2014370151383139210.1056/NEJMoa131373124716680
     [Google Scholar]
  16. ShahS.J. HeitnerJ.F. SweitzerN.K. AnandI.S. KimH.Y. HartyB. BoineauR. ClausellN. DesaiA.S. DiazR. FlegJ.L. GordeevI. LewisE.F. MarkovV. O’MearaE. KobuliaB. ShaburishviliT. SolomonS.D. PittB. PfefferM.A. LiR. Baseline characteristics of patients in the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial.Circ. Heart Fail.20136218419210.1161/CIRCHEARTFAILURE.112.97279423258572
     [Google Scholar]
  17. DesaiA.S. LewisE.F. LiR. SolomonS.D. AssmannS.F. BoineauR. ClausellN. DiazR. FlegJ.L. GordeevI. McKinlayS. O’MearaE. ShaburishviliT. PittB. PfefferM.A. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: A randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction.Am. Heart J.20111626966972.e1010.1016/j.ahj.2011.09.00722137068
     [Google Scholar]
  18. TsujimotoT. KajioH. Abdominal obesity is associated with an increased risk of all-cause mortality in patients with HFpEF.J. Am. Coll. Cardiol.201770222739274910.1016/j.jacc.2017.09.111129191321
     [Google Scholar]
  19. LavieC.J. PandeyA. LauD.H. AlpertM.A. SandersP. Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis.J. Am. Coll. Cardiol.201770162022203510.1016/j.jacc.2017.09.00229025560
     [Google Scholar]
  20. HuxleyR.R. LopezF.L. FolsomA.R. AgarwalS.K. LoehrL.R. SolimanE.Z. MaclehoseR. KonetyS. AlonsoA. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: The Atherosclerosis Risk in Communities (ARIC) study.Circulation2011123141501150810.1161/CIRCULATIONAHA.110.00903521444879
     [Google Scholar]
  21. MarcksN. AimoA. JanuzziJ.L.Jr VergaroG. ClericoA. LatiniR. MeessenJ. AnandI.S. CohnJ.N. GravningJ. UelandT. Bayes-GenisA. LupónJ. de BoerR.A. YoshihisaA. TakeishiY. EgstrupM. GustafssonI. GagginH.K. EggersK.M. HuberK. TentzerisI. RipoliA. PassinoC. Sanders-vanW.S. EmdinM. Brunner-LaR.H.P. Re-appraisal of the obesity paradox in heart failure: A meta-analysis of individual data.Clin. Res. Cardiol.202111081280129110.1007/s00392‑021‑01822‑133704552
     [Google Scholar]
  22. GuoL. LiuX. YuP. ZhuW. The “Obesity Paradox” in patients with HFpEF with or without comorbid atrial fibrillation.Front. Cardiovasc. Med.2022874332710.3389/fcvm.2021.74332735087875
     [Google Scholar]
  23. LiS. ZhengY. HuangY. HeW. LiuX. ZhuW. Association of body mass index and prognosis in patients with HFpEF: A dose-response meta-analysis.Int. J. Cardiol.2022361404610.1016/j.ijcard.2022.05.01835568057
     [Google Scholar]
  24. PathakR.K. MiddeldorpM.E. MeredithM. MehtaA.B. MahajanR. WongC.X. TwomeyD. ElliottA.D. KalmanJ.M. AbhayaratnaW.P. LauD.H. SandersP. Long-term effect of goal-directed weight management in an atrial fibrillation cohort.J. Am. Coll. Cardiol.201565202159216910.1016/j.jacc.2015.03.00225792361
     [Google Scholar]
  25. KristA.H. DavidsonK.W. MangioneC.M. BarryM.J. CabanaM. CaugheyA.B. DonahueK. DoubeniC.A. EplingJ.W.Jr KubikM. LandefeldS. OgedegbeG. PbertL. SilversteinM. SimonM.A. TsengC.W. WongJ.B. WongJ.B. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.JAMA2020324202069207510.1001/jama.2020.2174933231670
     [Google Scholar]
  26. HegdeS.M. ClaggettB. ShahA.M. LewisE.F. AnandI. ShahS.J. SweitzerN.K. FangJ.C. PittB. PfefferM.A. SolomonS.D. Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved cardiac function heart failure with an aldosterone antagonist).Circulation20171361198299210.1161/CIRCULATIONAHA.117.02800228637881
     [Google Scholar]
  27. ZhuW. LiangW. YeZ. WuY. HeX. XueR. WuZ. ZhouY. ZhaoJ. DongY. LiuC. Association of physical activity and risk of atrial fibrillation in heart failure with preserved ejection fraction.Nutr. Metab. Cardiovasc. Dis.202131124725310.1016/j.numecd.2020.08.02233097408
     [Google Scholar]
  28. KitzmanD.W. BrubakerP. MorganT. HaykowskyM. HundleyG. KrausW.E. EggebeenJ. NicklasB.J. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction.JAMA20163151364610.1001/jama.2015.1734626746456
     [Google Scholar]
  29. StrazzulloP. D’EliaL. CairellaG. GarbagnatiF. CappuccioF.P. ScalfiL. Excess body weight and incidence of stroke: Meta-analysis of prospective studies with 2 million participants.Stroke2010415e418e42610.1161/STROKEAHA.109.57696720299666
     [Google Scholar]
  30. MozaffarianD. BenjaminE.J. GoA.S. ArnettD.K. BlahaM.J. CushmanM. de FerrantiS. DesprésJ.P. FullertonH.J. HowardV.J. HuffmanM.D. JuddS.E. KisselaB.M. LacklandD.T. LichtmanJ.H. LisabethL.D. LiuS. MackeyR.H. MatcharD.B. McGuireD.K. MohlerE.R.III MoyC.S. MuntnerP. MussolinoM.E. NasirK. NeumarR.W. NicholG. PalaniappanL. PandeyD.K. ReevesM.J. RodriguezC.J. SorlieP.D. SteinJ. TowfighiA. TuranT.N. ViraniS.S. WilleyJ.Z. WooD. YehR.W. TurnerM.B. Heart disease and stroke statistics--2015 update: A report from the American Heart Association.Circulation20151314e29e32210.1161/CIR.000000000000015225520374
     [Google Scholar]
  31. AltaraR. GiordanoM. NordénE.S. CataliottiA. KurdiM. BajestaniS.N. BoozG.W. Targeting obesity and diabetes to treat heart failure with preserved ejection fraction.Front. Endocrinol.2017816010.3389/fendo.2017.0016028769873
     [Google Scholar]
  32. GentileF. SciarroneP. ZamoraE. De AntonioM. SantiagoE. DomingoM. AimoA. GiannoniA. PassinoC. CodinaP. Bayes-GenisA. LuponJ. EmdinM. VergaroG. Body mass index and outcomes in ischaemic versus non-ischaemic heart failure across the spectrum of ejection fraction.Eur. J. Prev. Cardiol.202128994895510.1177/204748732092761034402870
     [Google Scholar]
  33. ZamoraE. LupónJ. EnjuanesC. Pascual-FigalD. de AntonioM. DomingoM. Comín-ColetJ. VilaJ. PeñafielJ. FarréN. AlonsoN. SantesmasesJ. TroyaM. Bayés-GenísA. No benefit from the obesity paradox for diabetic patients with heart failure.Eur. J. Heart Fail.201618785185810.1002/ejhf.57627312985
     [Google Scholar]
  34. CohenJ.B. SchraubenS.J. ZhaoL. BassoM.D. CvijicM.E. LiZ. YardeM. WangZ. BhattacharyaP.T. ChirinosD.A. PrennerS. ZamaniP. SeiffertD.A. CarB.D. GordonD.A. MarguliesK. CappolaT. ChirinosJ.A. Clinical phenogroups in heart failure with preserved ejection fraction.JACC Heart Fail.20208317218410.1016/j.jchf.2019.09.00931926856
     [Google Scholar]
  35. ElkholeyK. PapadimitriouL. ButlerJ. ThadaniU. StavrakisS. Effect of obesity on response to spironolactone in patients with heart failure with preserved ejection fraction.Am. J. Cardiol.2021146364710.1016/j.amjcard.2021.01.01833529620
     [Google Scholar]
  36. NeefsJ. van den BergN.W.E. KrulS.P.J. BoekholdtS.M. de GrootJ.R. Effect of spironolactone on atrial fibrillation in patients with heart failure with preserved ejection fraction: Post-Hoc analysis of the randomized, placebo-controlled TOPCAT trial.Am J Cardiovasc Drugs.20202017380
     [Google Scholar]
/content/journals/cmc/10.2174/0929867330666230606100903
Loading
Association of Body Mass Index and Abdominal Obesity with Incidence of Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction
Curr. Med. Chem. 32, 3283 (2025); https://doi.org/10.2174/0929867330666230606100903
/content/journals/cmc/10.2174/0929867330666230606100903
/content/journals/cmc/10.2174/0929867330666230606100903
Loading

Data & Media loading...

Supplements

Supplementary material is available on the publisher's website along with the published article.

file format download Download

  • Article Type:     Research Article
Keyword(s): abdominal obesity; atrial fibrillation (AF); heart failure with preserved ejection fraction (HFpEF); Obesity; obesity paradox; spironolactone

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test