Correlation between body mass index and new-onset atrial fibrillation in patients with chronic heart failure

MA Yanhong; WANG Rui; LIANG Jinjin

doi:10.3969/j.issn.1674-4055.2025.11.016

Abstract：Objective To investigate the relationship between body mass index(BMI)and the risk of new-onset atrial fibrillation(NOAF)in patients with chronic heart failure(CHF).Methods This study was a retrospective cohort study.A total of 512 patients diagnosed with CHF were included at Zhangjiakou First Hospital between 2020 and 2023,and they were divided into 4 groups based on body mass index(BMI):underweight group(n=45),normal weight group(n=212),overweight group(n=203),and obese group(n=52).The primary outcome was NOAF.The follow-up duration was 3 y.Kaplan-Meier survival analysis,multivariate Cox regression analysis,restricted cubic spline(RCS)analysis,and subgroup analysis were used to evaluate the relationship between BMI and NOAF risk.Results Kaplan-Meier analysis showed that NOAF risk was significantly higher in underweight,overweight,and obese groups than that in normal weight group(Log-rank P=0.020).Multivariate Cox regression analysis indicated that compared with normal weight group,NOAF risk was significantly increased in overweight group(HR=1.56,95%CI:1.05～2.32,P=0.019)and obese group(HR=2.38,95%CI:1.38～4.10,P=0.002).RCS analysis revealed a U-shaped non-linear relationship between BMI and NOAF risk(non-linear P<0.001).Subgroup analysis found that the association between BMI and NOAF was stronger in females(P for interaction=0.046),and was only significant in subgroups with diastolic blood pressure(DBP)<90 mmHg(HR=1.19,95%CI:1.13～1.25,P<0.001)and B-type natriuretic peptide(BNP)≤300 pg/mL(HR=1.15,95%CI:1.08～1.22,P<0.001).Conclusion There is a U-shaped relationship between BMI and NOAF risk in CHF patients,and overweight and obese patients have a significantly increased risk.This association is more pronounced in female patients and those with lower DBP and BNP level.