Chandramouli C, Tay WT, Bamadhaj NS, et al. - The association between obesity (defined by BMI and abdominal measures) and heart failure (HF) outcomes was investigated in Asia via utilising the Asian Sudden Cardiac Death in Heart Failure registry (11 Asian regions including Taiwan, Hong Kong, China, India, Malaysia, Thailand, Singapore, Indonesia, Philippines, Japan, and Korea; 46 centres with enrolment between 1 October 2012 and 6 October 2016). Researchers prospectively investigated 5,964 patients with symptomatic HF (mean age 61.3 ± 13.3 years, 26% women, mean BMI 25.3 ± 5.3 kg/m², 16% with HF with preserved ejection fraction [HFpEF; ejection fraction ≥ 50%]). Among Asian patients with HF, they observed directionally opposite relationships of BMI and waist-to-height ratio (WHtR) with a composite outcome of all-cause death and hospitalization for HF—worse outcomes were observed in correlation with lower BMI, but higher WHtR. In the combined analysis, patients who were lean-fat (with low BMI but high WHtR) were more frequently women, from low-income countries or South/Southeast Asia, had diabetes, and had worse quality of life scores. Further, lean-fat patients exhibited the highest rate and risk of the composite outcome (HF hospitalization and all-cause mortality), regardless of heart failure subtype (with preserved vs reduced ejection fraction).