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To compare clinical features of patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) with those of patients with similar body mass index (BMI) but no HF and to examine the association between degree of obesity and risk for hospitalizations.

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disease caused by loss-of-function mutations in ABCC6 and characterized by elastic calcification leading to dermal, ocular, and ischemic vascular disease. We tested the hypothesis that heterozygosity for R1141X, the most frequent PXE-causing mutation in Caucasians, associated with risk of ischemic vascular disease, as previous studies suggested 4- to 11-fold risk of ischemic heart disease (IHD) in heterozygotes.

Introduction:In people with heart failure (HF) with preserved ejection fraction (HFpEF), the associations between BMI, comorbidities and outcomes are not well-defined. This retrospective cohort study examined the association between BMI and hospitalizations in patients with HFpEF.Hypothesis:Higher BMI is associated with more HF-related hospitalizations and shorter time to HF-related hospitalization.Methods:Data for patients with BMI ≥25 kg/m2at the time of HFpEF diagnosis were extracted from LCED, a US claims-electronic medical record data set. Patients were categorized into 5 BMI groups: overweight and obesity classes I-IV (Figure A). Negative binomial and Cox proportional hazard models were used to estimate associations between BMI and number of HF-related hospitalizations and risk of HF-related hospitalization during follow-up. Analyses were adjusted for relevant baseline comorbidities, with age, sex and diabetes status as effect modifiers.Results:Among 4,975 patients, median age was 74 years and 57.5% were female. Compared with the overweight group, higher BMI groups had a lower median age (years: overweight 80; obesity III 68; obesity IV 64), fewer patients with cardiovascular (CV) history (overweight 81.0%; obesity III 77.0%; obesity IV 66.0%) and a greater proportion of female patients (overweight 56.4%; obesity III 57.9%; obesity IV 69.0%) (Figure A). Mean HF-related hospitalizations/100 patient-years was higher for obesity III (12) and IV (16) vs overweight (10) (effect of BMI: p=0.002; Figure B). The hazard ratio [95% CI] for HF-related hospitalization was 1.36 [0.97; 1.91] and 1.86 [1.32; 2.64] for obesity III and IV, relative to overweight (effect of BMI: p=0.010).Conclusions:Results suggest even though patients with HFpEF in higher BMI groups are younger and have less CV history at baseline, higher BMI is associated with greater burden of HF-related hospitalizations during follow-up, irrespective of age, sex and diabetes status.