Table 4.

Comparison of Studies Examining the Obesity Paradox in Cardiovascular Disease, 2014 to Present

Reference	Main Findings
Powell-Wiley TM, Ngwa J, Kedebe S et al. 2017. Impact of BMI on Heart Failure with Preserved or Reduced Ejection Fraction: Data by Race/Ethnicity from Get With The Guidelines- Heart Failure Registry.	Race/ethnicity does not appear to modify the relationship between BMI and mortality among HF patients, and the obesity paradox appears to exist across BMI levels for HF patients with preserved or reduced ejection fraction.
Wang ZJ, Zhou YJ, Galper BZ, et al. Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta- analysis. Heart. 2015;101(20):1631–8.	There is a J-shaped relationship between BMI categories and risk of mortality among patients with CAD, with underweight patients having highest risk. Survival benefit of obesity was attenuated by 5-year follow up.
Vivo RP, Krim SR, Liang L, et al. Short- and long-term rehospitalization and mortality for heart failure in 4 racial/ethnic populations. J Am Heart Assoc. 2014;3:e001134.	Black and Hispanic HF patients had higher 30-day and 1-year hospital readmission rates, but lower 30-day and 1-year mortality compared to white patients, after adjustment for socioeconomic status and patient/hospital characteristics.
Shah R, Gayat E, Januzzi JL, Jr., et al. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. J Am Coll Cardiol. 2014;63:778–85.	There is an obesity paradox in 1-year mortality of acute decompensated HF patients globally, after adjustment for patient characteristics. However, the association of BMI and outcome is restricted to specific groups, such as non-diabetic, older patients with de novo HF diagnosis or HF with reduced LVEF.
Padwal R, McAlister FA, McMurray JJV et al. The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Int J Obesity. 2014;38:1110–1114.	There is a U-shaped mortality curve among HF patients with preserved or reduced LVEF. Lowest mortality was seen in patients with BMI between 30 and 30.4 kg/m2. After adjustment for confounders, high BMI status remained significantly associated with lower mortality risk.
Ziaeian B, Heidenreich PA, Xu H, et al. Race/ethnic differences in outcomes among hospitalized Medicare patients with heart failure and preserved ejection fraction. J Am Coll Cardiol HF. 2017;5:483–493.	Lower mortality risk after hospitalization for HFpEF was found in black, Hispanic, and Asian patients after adjusting for SES and patient/hospital characteristics. Black and Hispanic HFpEF patients had higher readmission rates, but lower short- and long-term mortality.