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

Objectives: To determine whether risk for implantable cardioverter-defibrillator (ICD) therapy varies by body mass index (BMI) in systolic heart failure (HF).

Background: It is unknown whether obesity increases sudden death risk in patients with systolic HF.

Methods: Secondary 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/m(2)): normal (18.5 to <25), overweight (25 to <30), and obese (≥30).

Results: Overweight 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.

Conclusions: There was an inverted U-shaped relationship between BMI and risk for first ICD therapy among systolic HF patients, with highest risk in overweight BMI.