Differential effects of overweight/obesity depending on the severity of heart failure complicating acute myocardial infarction in Japan

Background: The existence of a paradoxical association between overweight/obesity and survival benefits, the so-called obesity paradox, in heart failure (HF) as well as coronary artery disease (CAD) remains contentious. Pre-viously, we reported that a past history of CAD negated the obesity paradox in the general population with acute HF. Herein, we further focused on HF complicating acute myocardial infarction (AMI) and compared the prognos-tic effects of overweight/obesity with respect to the severity of HF.Methods: We conducted a multicenter retrospective study of 7265 consecutive patients with AMI. The severity of HF was categorized according to the Killip classification. Overweight/obesity was defined as a body mass index (BMI) of & GE;25 kg/m2. The interaction between overweight/obesity and the Killip classification for in-hospital mor-tality was tested in the entire cohort. Multivariable logistic regression analyses were performed to examine the effects of overweight/obesity on in-hospital mortality.Results: Across the entire study cohort, 1931 patients had HF. Overweight/obesity had a significant associ-ation with reductions in in-hospital mortality in patients with mild HF (Killip class II; odds ratio [OR], 0.284; P = 0.019). Conversely, overweight/obesity was a significant risk factor for in-hospital mortality in patients with severe HF (Killip class IV; OR, 2.152; P = 0.001). The effects of overweight/obesity on in-hospital mortality in patients with moderate HF (Killip class III) were intermediate between those with mild HF and severe HF.Conclusion: Opposing effects of overweight/obesity on in-hospital mortality in patients with mild HF versus severe HF were demonstrated, suggesting a balance between beneficial and deleterious effects of over-weight/obesity may be inclined toward the latter with the severity of HF complicating AMI.& COPY; 2022 Elsevier Inc. All rights reserved.