Association between body mass index and clinical outcomes in patients with acute myocardial infarction and reduced systolic function: Analysis of PARADISE-MI trial data

Offer Amir; Gabby Elbaz-Greener; Shemy Carasso; Brian Claggett; Olga Barbarash; Azfar Zaman; Christina Christersson; Songsak Kiatchoosakun; John Anonuevo; Grzegorz Opolski; Mody F Vaghaiwalla; Peter van der Meer; Yinong Zhou; Douglas L Mann; Lars Kober; Gabriel Steg; Karola Jering; Ian Kulac; Carmine G De Pasquale; John J V McMurray; Marc A Pfeffer; PARADISE‐MI Investigators and Committees

doi:10.1002/ejhf.3542

Association between body mass index and clinical outcomes in patients with acute myocardial infarction and reduced systolic function: Analysis of PARADISE-MI trial data

Eur J Heart Fail. 2024 Dec 18. doi: 10.1002/ejhf.3542. Online ahead of print.

Authors

Offer Amir^#^{1

2}, Gabby Elbaz-Greener^#^{1

2}, Shemy Carasso^{2

3}, Brian Claggett⁴, Olga Barbarash⁵, Azfar Zaman⁶, Christina Christersson⁷, Songsak Kiatchoosakun⁸, John Anonuevo⁹, Grzegorz Opolski¹⁰, Mody F Vaghaiwalla¹¹, Peter van der Meer¹², Yinong Zhou¹³, Douglas L Mann¹⁴, Lars Kober¹⁵, Gabriel Steg¹⁶, Karola Jering⁴, Ian Kulac⁴, Carmine G De Pasquale¹⁷, John J V McMurray¹⁸, Marc A Pfeffer⁴; PARADISE‐MI Investigators and Committees

Affiliations

¹ Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.
² Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
³ Shaare Zedek Medical Center, Jerusalem, Israel.
⁴ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Federal State Budgetary Institution, Kemerovo, Russia.
⁶ Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK.
⁷ Department of Medical Science, Cardiology, Uppsala University, Uppsala, Sweden.
⁸ Cardiology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁹ Department of Medicine, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines.
¹⁰ Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
¹¹ Heart Failure and Preventive Cardiology Programs, Department of Veterans Affairs Greater Los Angeles, University of California, Los Angeles, CA, USA.
¹² Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
¹³ Novartis Inc., East Hanover, NJ, USA.
¹⁴ Cardiovascular Division, Washington University, School of Medicine, St. Louis, MS, USA.
¹⁵ Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark.
¹⁶ University Paris-Cite Institute, University de France, Hospital Bichat, Paris, France.
¹⁷ Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, SA, Australia.
¹⁸ School of Cardiovascular & Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.

^# Contributed equally.

PMID: 39692068
DOI: 10.1002/ejhf.3542

Abstract

Aims: The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship.

Methods and results: The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data. The cohort comprised patients with AMI and pulmonary congestion and/or left ventricular ejection fraction ≤40%. Patients were categorized into six World Health Organization BMI subgroups. The primary outcome of interest was the composite endpoint of cardiovascular death, heart failure (HF)-associated hospitalization, and outpatient symptomatic HF episodes. The mean baseline BMI of the cohort was 28.1 ± 5.0 kg/m². The lowest rate of the primary composite endpoint (6.2/100 patient-years) was observed in overweight patients (BMI 25-29.9 kg/m²), while the highest rates were found in the lowest and highest BMI subgroups (8.4/100 patient-years for BMI <18.5 kg/m² and 9.7/100 patient-years for BMI >40 kg/m²). There was no significant interaction between BMI and the treatment effect of ARNI versus ACE-I on the primary composite outcome (p = 0.73). Additionally, no significant differences in the incidence of adverse events or serious adverse events were noted across the BMI subgroups.

Conclusions: In AMI with AHF patients, the relationship between BMI and the primary composite outcome is non-linear, with the lowest event rates observed in overweight individuals. Outcomes and safety profiles for ARNI and ACE-I treatments were similar across BMI subgroups.

Keywords: Acute heart failure; Angiotensin receptor–neprilysin inhibitor; Angiotensin‐converting enzyme inhibitors; Body mass index; Obesity paradox.