Association of Long‐Term Body Mass Index Variability With the Development of Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction Across Patterns of Weight Change

• Published in: Journal of the American Heart Association Vol. 14; no. 18; p. e039976
• Main Authors: Yu, Zeshui, Chen, Yuqing, Miranda, Oshin, Qi, Meiyuzhen, Zhang, Manling, Feng, Ning, Ryan, Timothy P., Schloot, Nanette Cathrin, Chen, Yu, Sam, Flora, Wang, Lirong
• Format: Journal Article
• Language: English
• Published: England 11.09.2025
• Subjects: Aged; Body Mass Index; Female; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Incidence; Male; Middle Aged; Obesity - complications; Obesity - diagnosis; Obesity - epidemiology; Obesity - physiopathology; Retrospective Studies; Risk Assessment; Risk Factors; Stroke Volume - physiology; Time Factors; Ventricular Function, Left; Weight Gain; Weight Loss; longitudinal study; BMI variability; HFpEF; HFrEF; weight change pattern
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.039976

Body mass index (BMI) variability is a risk factor for various adverse cardiovascular outcomes. However, the specific associations between BMI variability and the risk of developing heart failure with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF), particularly across multiple weight change trends, remain unexplored. This retrospective cohort study analyzed electronic health records from a sample of patients with overweight or obesity. BMI variability was assessed over a 5-year period using average successive variability, with patients categorized into 3 groups: weight loss, stable weight, and weight gain. We subsequently followed 50 812 eligible patients to monitor the incidence of HFpEF and HFrEF. Cox regression models were applied to examine the differential association between BMI variability and HFpEF and HFrEF risk. Over a median follow-up of 4.52 years, 2128 patients developed HFpEF and 1121 developed HFrEF. After adjusting for relevant confounders, elevated BMI variability was associated with an increased risk of HFpEF. The hazard ratios (HRs) of HFpEF for each 1-SD increment in average successive variability of BMI were 1.37 (95% CI, 1.17-1.59) in the weight loss group and 1.24 (95% CI, 1.11-1.40) in the stable weight group. Additionally, when analyzed as a binary variable divided by the median, BMI variability above the median was associated with higher risks of HFpEF compared with those below the median, with the corresponding HRs being 1.47 (95% CI, 1.21-1.79) for the weight loss group and 1.20 (95% CI, 1.06-1.35) for the stable weight group. Among patients who experienced weight gain, BMI variability was not significantly associated with the risk of incident HFpEF or HFrEF (HR, 1.16 [95% CI, 0.88-1.53]; modeled as a continuous variable). In this large cohort of individuals living with overweight or obesity, greater variability in BMI was significantly associated with a higher risk of developing HFpEF among those with reduced or stable weight.