Association of implantable defibrillator therapy risk with body mass index in systolic heart failure

ObjectivesTo determine whether risk for implantable cardioverter-defibrillator (ICD) therapy varies by body mass index (BMI) in systolic heart failure (HF).BackgroundIt is unknown whether obesity increases sudden death risk in patients with systolic HF.MethodsSecondary analysis of patients with HF, left ventricular ejection fraction ≤0.40 and ICD (N = 464) was performed using Cox regression modeling to assess risk for first delivered ICD therapy, with patients grouped by BMI (kg/m2): normal (18.5 to <25), overweight (25 to <30), and obese (≥30).ResultsOverweight patients, compared with patients with normal BMI, had greater adjusted risk for first ICD therapy (HR 1.66; 95% CI 1.02–2.71; P = 0.04), whereas obese BMI was not associated with risk for first ICD therapy.ConclusionsThere was an inverted U-shaped relationship between BMI and risk for first ICD therapy among systolic HF patients, with highest risk in overweight BMI.