2381/42719 Koen W. Streng Koen W. Streng Adriaan A. Voors Adriaan A. Voors Hans L. Hillege Hans L. Hillege Stefan D. Anker Stefan D. Anker John G. Cleland John G. Cleland Kenneth Dickstein Kenneth Dickstein Gerasimos Filippatos Gerasimos Filippatos Marco Metra Marco Metra Leong L Ng Leong L Ng Piotr Ponikowski Piotr Ponikowski Nilesh J. Samani Nilesh J. Samani Dirk J. van Veldhuisen Dirk J. van Veldhuisen Aeilko H. Zwinderman Aeilko H. Zwinderman Faiez Zannad Faiez Zannad Kevin Damman Kevin Damman Peter van der Meer Peter van der Meer Chim C. Lang Chim C. Lang Waist-to-hip ratio and mortality in heart failure. University of Leicester 2018 Body mass index Heart failure Mortality Obesity Waist-to-hip ratio 2018-08-16 09:07:56 Journal contribution https://figshare.le.ac.uk/articles/journal_contribution/Waist-to-hip_ratio_and_mortality_in_heart_failure_/10246229 AIMS: A higher body mass index (BMI) is associated with better survival in heart failure (HF) patients, also known as the obesity paradox. However, BMI does not account for body composition. We therefore analysed the association between abdominal fat, measured via waist-to-hip ratio (WHR), BMI and all-cause mortality in patients with HF. METHODS AND RESULTS: For this analysis, 1738 patients from the Scottish BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) validation study were included. Patients without waist and hip measurements were excluded. WHR was defined as waist circumference/hip circumference, divided into tertiles and split for sex. A linear regression of principal components from an extensive panel of biomarkers was performed to provide insight in the pathophysiology behind a higher WHR. In total, 1479 patients were included, of which 33% were female and mean age was 75 ±11 years. A higher WHR was independently associated with a higher BMI, a higher prevalence of diabetes and higher New York Heart Association functional class. There was a significant interaction between sex and WHR on its association with mortality (P <0.001). In women, a higher WHR was associated with a higher mortality risk [hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.37-3.63; P =0.001], whereas no significant association was found in men (HR 0.87, 95% CI 0.63-1.20; P = 0.409). We found a strong association between a higher WHR and elevated markers of inflammation and MAPK cascade in women, while these associations were less profound in men. CONCLUSIONS: A higher WHR was associated with a higher risk of death in female but not in male HF patients. These findings challenge the obesity paradox, and suggest that fat deposition is pathophysiologically harmful and may be a target for therapy in female patients with HF.