It has been shown in several studies that despite being an independent risk factor for the development of HF, obesity is associated with lower mortality in patients with established HF, giving rise to the phrase “obesity paradox.” Does that paradox apply to the Moroccan population?

To study the impact of obesity on chronic heart failure with reduced ejection fraction (HFrEF) features and outcomes.

Transversal study conducted between May 2006 and June 2019 including patients>14 years with HFrEF, followed-up in our department. Obesity was defined as a body mass index (BMI)≥30kg/m². We studied 2 groups of patients: group1 of obese patients and group2 of patients with normal BMI.

We collected 3412 patients: 723 (21.20%) in group 1, 2689 (78.8%) in group 2. Male gender rate was 62.1% vs. 62.2% (P=0.9). Mean age was 63.34±11.60 versus 66.90±13.15 years (P<0.001). Regarding cardiovascular risk factors: hypertension in 47.4% vs. 39% (P<0.001), diabetes mellitus in 37.5% vs. 30% (P<0.001), dyslipidemia in 20.2% vs. 10.4% (P<0.001), Smoking in 31.3% vs. 33.1% (P<0.001). Stroke in 12.6% vs. 14.6% (P<0.001), thyroid dysfunction in 2.3% vs. 1.5% (P<0.001), end stage CKD in 5.7% vs. 7.1% (P<0.001). Ischemic heart disease was represented in 61.1% vs. 54.6%, dilated cardiomyopathy in 6% vs. 5.8%, valvular heart disease in 2.8% vs. 4.3%, hypertrophic cardiomyopathy in 0.9% vs. 0% (P<0.001). Atrial fibrillation in 14.2% vs. 11% (P<0.001). Echocardiographic features: LVEDDD was 57.87±8.24mm vs. 57.78±8.94mm (P=0.875), mean LVEF was 34.52±13.02% vs. 34.73±13.10% (P=0.884), elevated left ventricle filling pressures in 17.5% vs. 25.5% (P<0.001), severe secondary mitral regurgitation in 4.6% vs. 7% (P<0.001). H:F hospitalization rate was 20.4% vs. 25.7% (P<0.001).

Obesity paradox is confirmed in our population as obese HF patients are less symptomatic and have lower rates of hospitalization for HF and lower mortality rate.