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Article

Impact of Metabolically Healthy Obesity on Cardiovascular Outcomes in Older Adults with HFpEF: Insights from a Nationwide Sample

by
Adil Sarvar Mohammed
1,*,
Hafeezuddin Ahmed
2,
Sachin Singh
1,
Cyrus Mutinda Munguti
3,
Lakshmi Subramanian
4,
Sashwath Srikanth
5,
Lakshmi Sai Meghana Kodali
6,
Maya Asami Takagi
7,
Umera Yasmeen
8,
Hassaan Imtiaz
9,
Akhil Jain
10,
Saad Chaudhry
11 and
Rupak Desai
12,*
1
Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, USA
2
Department of Internal Medicine, DMC Sinai Grace–Detroit Medical Center, Detroit, MI 48235, USA
3
Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
4
Department of Cardiovascular Medicine, University of Tennessee Health Science Center, Chattanooga, TN 37403, USA
5
Department of Cardiovascular Medicine, Baylor Medical Center, The Heart Hospital, Plano, TX 75093, USA
6
Department of Public Health & Health Sciences, University of Michigan-Flint, Flint, MI 48502, USA
7
Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, USA
8
Department of Internal Medicine, Mamata Medical College, Khammam 507002, India
9
Department of Internal Medicine, McLaren Health, Bay City, MI 48708, USA
10
Department of Hematology and Oncology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA
11
Department of Geriatrics, Central Michigan University, Saginaw, MI 48602, USA
12
Independent Outcomes Researcher, Atlanta, GA 30033, USA
 
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*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5495; https://doi.org/10.3390/jcm14155495 (registering DOI)
Submission received: 3 July 2025 / Revised: 25 July 2025 / Accepted: 31 July 2025 / Published: 4 August 2025
(This article belongs to the Section Cardiology)
Versions Notes

Abstract

Background: Clinical outcomes among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF) in the setting of metabolically healthy obesity (MHO) remain insufficiently explored. This study aimed to evaluate whether MHO status is associated with different rates of major adverse cardiac and cerebrovascular events (MACCEs) during HFpEF-related hospitalizations compared to patients without MHO. Methods: Data from the 2019 National Inpatient Sample (NIS) database was analyzed using relevant ICD-10 codes to identify HFpEF admissions in older adults. Propensity score matching (1:1) was applied to generate balanced cohorts of patients with and without MHO. Multivariable adjustments were performed to assess primary outcomes, including MACCEs, all-cause mortality (ACM), acute myocardial infarction (AMI), dysrhythmia, cardiac arrest (CA), and stroke. Statistical significance was set at p < 0.05. Results: Each MHO cohort included 22,405 patients with a median age of 75 years. The MHO+ group demonstrated a significantly higher risk of dysrhythmia (OR 1.32, 95% CI 1.21–1.43, p < 0.001). Interestingly, an “obesity paradox” was observed, as the MHO+ cohort had lower odds of MACCEs (OR 0.70, 95% CI 0.61–0.81, p < 0.001), ACM (OR 0.66, 95% CI 0.54–0.82, p < 0.001), and AMI (OR 0.71, 95% CI 0.59–0.86, p = 0.001) compared to MHO−. No significant differences were found for CA or stroke between the groups. Conclusions: Although the MHO+ group had an elevated risk of dysrhythmia, they exhibited more favorable outcomes in terms of MACCEs, ACM, and AMI—supporting the concept of an “obesity paradox.” Further research is needed to better understand the role of MHO as a comorbid condition in patients with HFpEF.
Keywords: metabolically healthy obesity; HFpEF; dysrhythmia; MACCE; all-cause mortality; acute myocardial infarction metabolically healthy obesity; HFpEF; dysrhythmia; MACCE; all-cause mortality; acute myocardial infarction

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MDPI and ACS Style

Mohammed, A.S.; Ahmed, H.; Singh, S.; Munguti, C.M.; Subramanian, L.; Srikanth, S.; Kodali, L.S.M.; Takagi, M.A.; Yasmeen, U.; Imtiaz, H.; et al. Impact of Metabolically Healthy Obesity on Cardiovascular Outcomes in Older Adults with HFpEF: Insights from a Nationwide Sample. J. Clin. Med. 2025, 14, 5495. https://doi.org/10.3390/jcm14155495

AMA Style

Mohammed AS, Ahmed H, Singh S, Munguti CM, Subramanian L, Srikanth S, Kodali LSM, Takagi MA, Yasmeen U, Imtiaz H, et al. Impact of Metabolically Healthy Obesity on Cardiovascular Outcomes in Older Adults with HFpEF: Insights from a Nationwide Sample. Journal of Clinical Medicine. 2025; 14(15):5495. https://doi.org/10.3390/jcm14155495

Chicago/Turabian Style

Mohammed, Adil Sarvar, Hafeezuddin Ahmed, Sachin Singh, Cyrus Mutinda Munguti, Lakshmi Subramanian, Sashwath Srikanth, Lakshmi Sai Meghana Kodali, Maya Asami Takagi, Umera Yasmeen, Hassaan Imtiaz, and et al. 2025. "Impact of Metabolically Healthy Obesity on Cardiovascular Outcomes in Older Adults with HFpEF: Insights from a Nationwide Sample" Journal of Clinical Medicine 14, no. 15: 5495. https://doi.org/10.3390/jcm14155495

APA Style

Mohammed, A. S., Ahmed, H., Singh, S., Munguti, C. M., Subramanian, L., Srikanth, S., Kodali, L. S. M., Takagi, M. A., Yasmeen, U., Imtiaz, H., Jain, A., Chaudhry, S., & Desai, R. (2025). Impact of Metabolically Healthy Obesity on Cardiovascular Outcomes in Older Adults with HFpEF: Insights from a Nationwide Sample. Journal of Clinical Medicine, 14(15), 5495. https://doi.org/10.3390/jcm14155495

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