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Redefining heart failure subtypes according to skeletal muscle mass

Nature Reviews Cardiology volume 23, pages 79–80 (2026)Cite this article

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In this Comment, I propose an outcome-oriented classification of heart failure based on skeletal muscle mass. By distinguishing between heart failure with either preserved or reduced muscle mass, this conceptual framework represents a major step towards abandoning the misleading concept of the ‘obesity–mortality paradox’ in cardiology.

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Fig. 1: Skeletal muscle mass as a key determinant of mortality in patients with heart failure.

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Acknowledgements

N.S. gratefully acknowledges support from the Netherlands Organization for Scientific Research (Nederlandse Organisatie voor Wetenschappelijk Onderzoek), co-funded by ERA4Health through the CARDINNOV 2023 call, as part of the EnerLIGHT project (grant agreement no. 101095426 of the EU Horizon Europe Research and Innovation Programme). N.S. also thanks M. A. Ikram (Erasmus University Medical Center, Rotterdam, Netherlands) for his valuable feedback on the manuscript.

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  1. Erasmus Medical Center, Cardiovascular Research Institute, Thorax Center, Department of Cardiology, Rotterdam, Netherlands

    Navin Suthahar

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  1. Navin Suthahar
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Correspondence to Navin Suthahar.

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Suthahar, N. Redefining heart failure subtypes according to skeletal muscle mass. Nat Rev Cardiol 23, 79–80 (2026). https://doi.org/10.1038/s41569-025-01237-9

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