Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality

Abstract

T he prevalence of overweight and obesity has increased rapidly over the last decades in all areas of the world. 1 This has raised serious public health concerns owing to the association between overweight and obesity and the increased risk of a wide range of chronic diseases, including cardiovascular diseases, type 2 diabetes mellitus, total mortality, and several types of cancer. 2-4 Clinical Perspective on p 649Heart failure is a major public concern. Heart failure affected ≈5 million Americans in 2005, and economic costs are estimated at US $27.9 billion.5 Mortality in heart failure remains high, ranging from 20% to 40% despite advances in the management of heart failure. 6,7 Several prospective studies have reported increased risk of heart failure with a greater body mass index (BMI), and although most studies report an increased risk of heart failure in the obese range (BMI ≥30 kg/m 2 ), it is less clear whether overweight (BMI, kg/ m 2 ) increases the risk; some studies found a significant association, 10,16,17,20,25,31,32 whereas others did not. 8,12,19,21,23,[27][28][29][30]33,34 A pooled analysis of 32 cohort studies in Asia and the Pacific found an increased risk of heart failure mortality among obese individuals, but there was no association among overweight subjects. 35 However, it is possible that the association between BMI and heart failure differs for incidence and mortality because mortality depends on both the incidence and prognosis after heart failure is established and because there is indication of an obesity paradox observed in heart failure patients, with improved survival among overweight and obese persons with established heart failure. 36 This uncertainty is also reflected in the Heart Failure Society of America practice guidelines in which the goal for management of BMI is set at a BMI <30 kg/m 2 . 37 However, this may be a suboptimal goal if risk of heart failure incidence also increases in overweight subjects.Background-Obesity has been associated with increased risk of heart failure, but whether overweight also increases risk is unclear. It is also unclear whether abdominal adiposity is more strongly associated with heart failure risk than general adiposity. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relationship between general and abdominal adiposity and the risk of heart failure. Methods and Results-PubMed and Embase databases were searched up to October 10, 2014. Summary relative risks were calculated using random-effects models. A total of 28 studies (27 publications) were included. Twenty-three prospective studies with >15 905 incident cases among 647 388 participants were included in the analysis of body mass index and heart failure incidence, and 4 studies were included for heart failure mortality. The summary relative risk for a 5-unit increment in body mass index was 1.41 (95% confidence interval, 1.34-1.47; I 2 =83%) for heart failure incidence and 1.26 (95% confidence interval, 0....

Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose–response meta-analysis of prospective studies

“…This could indicate that part of the association between adiposity and atrial fibrillation may be mediated by heart failure. This is consistent with our previous finding of an increased risk of heart failure related to both general and abdominal adiposity [7] and with the increased risk of atrial fibrillation among patients with heart failure [53]. Although the heterogeneity between studies was high, this appeared to be largely due to different effect sizes between studies, rather than differences in the direction of the association, as all but one study found a positive association.…”

“…Adiposity is associated with increased risk of hypertension [2], insulin resistance [69], diabetes [70], obstructive sleep apnea [71], coronary heart disease [72], and heart failure [7], which are established risk factors for atrial fibrillation [53, 73, 74]. Adiposity is associated with increased risk of left ventricular hypertrophy [75–77] and left atrial size [78, 79], and the latter may be due to hypertension, volume overload, left ventricular diastolic abnormalities, autonomic dysfunction and enhanced neurohormonal activation [80, 81].…”

Obesity and Subtypes of Incident Cardiovascular Disease

“…( J Am Heart Assoc. 2016;5:e003921 doi: 10.1161/JAHA.116.003921) Key Words: coronary heart disease • epidemiology • heart failure • obesity • stroke O besity is a common risk factor for several subtypes of cardiovascular disease (CVD), including coronary heart disease (CHD), stroke, and heart failure (HF) [1][2][3][4] ; however, increasing evidence suggests that obesity leads to various subtypes of CVD through multiple distinct pathways. Some traditional risk factors, including hypertension, diabetes mellitus, and dyslipidemia, are established as mediators between obesity and atherosclerotic vascular disease.…”

Bioimpedance and New‐Onset Heart Failure: A Longitudinal Study of >500 000 Individuals From the General Population

“…Next, we assessed the relationships between the top 15 features associated with heart failure from the gradient boosting machine model and incident heart failure by using Cox proportional hazards regression in 2 sets of models: (1) adjusting for age and sex; and (2) additionally adjusting for body mass index, systolic and diastolic blood pressure, antihypertensive treatment, alcohol consumption, diabetes mellitus, smoking status, prevalent chronic renal failure, and prevalent coronary heart disease, all of which are established risk factors for heart failure 7, 8, 9, 10, 11. Continuous variables were entered as restricted cubic splines to account for any nonlinear associations.…”