{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:13:04Z","timestamp":1788858784030,"version":"build-2803163510"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002551","name":"Seoul National University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002551","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Both diabetes mellitus (DM) and obesity are established risk factors for heart failure (HF). While obesity worsens DM outcomes, it may paradoxically confer survival benefits in HF patients. This study investigated the impact of obesity-DM interaction on clinical outcomes in HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      We pooled data from two prospective Korean HF registries (KorHF,\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      3,200; KorAHF,\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      5,625). Patients were classified by BMI (\u2264\u2009\/\u2009&gt;\u200923\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and DM status. Primary endpoints were in-hospital and one-year post-discharge mortality. Among 8,383 patients (mean age 68.2\u00a0years; 52.0% male; mean BMI 23.3\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 34.0% had DM. Patients were categorized as overweight non-diabetic (31%), overweight diabetic (19%), lean non-diabetic (35%), and lean diabetic (15%). Lean diabetic patients had the worst baseline characteristics and outcomes, while overweight non-diabetic patients had the most favorable profile. In this retrospective analysis, after multivariable adjustment, overweight diabetic patients had a significantly lower one-year mortality risk than lean diabetic patients (adjusted HR 0.65, 95% CI 0.53\u20130.79;\n                      <jats:italic>P\u2009&lt;\u2009<\/jats:italic>\n                      0.001), as did overweight non-diabetic patients. The association between overweight status and in-hospital mortality was attenuated and no longer statistically significant after adjustment (overweight diabetic: adjusted OR 0.68, 95% CI 0.45\u20131.03,\n                      <jats:italic>P\u2009=\u2009<\/jats:italic>\n                      0.069). No significant BMI\u2009\u00d7\u2009DM interaction was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overweight status was associated with better prognosis in HF patients regardless of DM status, confirming the obesity paradox in both diabetic and non-diabetic HF populations. This obesity paradox was robust for one-year mortality but, after multivariable adjustment, was not independently associated with in-hospital mortality. Given the observational design, these findings should be interpreted as associations rather than evidence of a causal effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>KorAHF, ClinicalTrials.gov NCT01389843 (propectively registered); KorHF, ClinicalTrials.gov NCT04329234 (prospectively registered).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-03007-0","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:51:14Z","timestamp":1788853874000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity paradox in heart failure with and without diabetes mellitus: a retrospective cohort study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0814-8321","authenticated-orcid":false,"given":"Ohchul","family":"Kwon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4209-655X","authenticated-orcid":false,"given":"Minjae","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9611-1490","authenticated-orcid":false,"given":"Jin Joo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"3007_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.36628\/ijhf.2022.0028","volume":"5","author":"KS Lee","year":"2023","unstructured":"Lee KS, Noh J, Park SM, Choi KM, Kang SM, Won KC et al (2023) Evaluation and management of patients with diabetes and heart failure: a Korean Diabetes Association and Korean Society of Heart Failure consensus statement. 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Trial registration: ClinicalTrials.gov NCT01389843. KorHF: B-1807\u2013483-302 (Seoul National University Bundang Hospital,\u00a0Seongnam, Republic of Korea). Trial registration: ClinicalTrials.gov NCT04329234.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The patients gave their written informed consent prior to being registered in KorHF and KorAHF registry.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}