A body shape index for visceral fat and its changes predict cardiovascular outcomes of heart failure with preserved ejection fraction

Abstract Aims This study aimed to investigate the relationship between visceral adipose tissue (VAT), measured using a body shape index (ABSI), and outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods ABSI data and cardiovascular outcomes were obtained from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. ABSI was calculated using waist circumference, body mass index, and height. ABSI values were categorized into tertiles for analysis (≤0.078, 0.078–0.084, and >0.084). Results In total, 3319 patients with HFpEF were enrolled during a mean follow-up period of 3.9 years. ABSI was positively associated with a high risk of cardiovascular events in patients with HFpEF after multivariate adjustment. In the highest tertile, higher risks of all-cause mortality [hazard ratio (HR): 1.464, 95% confidence interval (CI): 1.150–1.864], cardiovascular death (HR: 1.685, 95% CI: 1.241–2.289), myocardial infarction (MI) (HR: 1.778, 95% CI: 1.088–2.904), and major adverse cardiovascular events (MACEs) (HR: 1.430, 95% CI: 1.123–1.822) were noted. Patients with previous or current high ABSI had poorer long-term prognoses, with increased risks of all-cause mortality (HR: 1.635, 95% CI: 1.116–2.396), cardiovascular death (HR: 1.724, 95% CI: 1.071–2.775), MI (HR: 2.021, 95% CI: 0.878–4.653), and MACEs (HR: 1.653, 95% CI: 1.117–2.447). Conclusion ABSI was independently associated with long-term prognosis in patients with HFpEF, and a history of high ABSI was associated with a poorer prognosis later in life, underscoring the importance of reducing VAT in HFpEF.