Aim: To investigate whether patients with acute heart failure and concomitant metabolic syndrome have worse outcome, longer hospitalisation, higher in-hospital and three-month follow-up mortality.

Patients and Methods: The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorized according to the ESC and ACCF/AHA Guidelines for HF.

Results: Mean age was 75.2 years (SD 10.3), 52% were female, mean body mass index (BMI) 28.8 kg/m² (SD 5.4). Hospital mortality was 14.5%, three-month 27.4%, length of hospitalisation 11.34 (SD 9.26) days. Patients with metabolic syndrome were hospitalized longer comparing to those without metabolic syndrome. Unexpected, patients with acute heart failure and concomitant metabolic syndrome had better survival. Univariate analysis revealed higher odds ratio for in-hospital and three-month mortality in patients without metabolic syndrome. Paradoxically, higher BMI (≥25 kg/m²), total cholesterol and blood pressure were associated with lower odds ratio of in-hospital and three-month mortality. Lower HDL and higher IL-6 were associated with higher three-month mortality.

Conclusion: Patients with metabolic syndrome were longer hospitalized, patients without metabolic syndrome had higher odds ratio of in-hospital and three-month mortality. Results of this study suggest that “reverse epidemiology” emerged (1-3). Reverse epidemiology is paradoxical association of lowered BMI, total cholesterol concentration, and blood pressure with higher morbidity and mortality in patients with heart failure. To conclude, results emphasize importance of diagnosing metabolic syndrome, lipid control and hypolipemic therapy re-evaluation.