Relationship between waist-to-height ratio and heart failure outcome: A single-centre prospective cohort study

Aims: This study sought to evaluate the correlation between waist-to-height ratio (WHtR) and heart failure (HF) outcomes across different ejection fraction (EF) categories. Methods and results: A prospective cohort study was conducted at a comprehensive tertiary hospital in China. The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow-up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all-cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all-cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 ± 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (≥0.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 ± 1.55 vs. 3.36 ± 0.90 mmol/L), TG (1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L), and LDL-C (2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L) compared with patients with low WHtR (<0.50). NT-proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow-up period. The incidence of all-cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30–2.58), 1.96 (1.34–2.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF/low WHtR exhibited a markedly elevated risk of all-cause mortality [HR = 2.31; (95% CI: 1.24–4.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92–8.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19–17.76)] compared with patients with HFrEF/high WHtR. WHtR has a negligible effect on the risk of all-cause and cardiovascular mortality in heart failure patients with preserved EFs. Conclusions: The obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF.