Relationship of normal-weight central obesity with the risk for heart failure and atrial fibrillation: analysis of a nationwide health check-up and claims database

Abstract

Aims There have been scarce data on the relationship of normal-weight central obesity (NWCO) with the subsequent risk for heart failure (HF) and atrial fibrillation (AF). Using a nationwide health check-up and administrative claims database, we sought to clarify whether NWCO would be associated with the incidence of HF and AF. Methods and Results Medical records of 1,697,903 participants without prior history of cardiovascular disease (CVD) and normal-weight (body mass index of 18.5–23.0 kg/m2) were extracted from the JMDC Claims Database, which is a health check-up and claims database. We defined NWCO as normal-weight and CO (waist circumference ≥ 90 cm for men or ≥ 80 cm for women). The median age was 44.0 (37.0–52.0) years and 872,578 (51.4%) participants were men. Overall, 154,778 individuals (9.1%) had CO. The mean follow-up period was 3.3±2.6 years. Participants with NWCO were older and more likely to be women than those without. HF and AF occurred in 26,936 (1.6%) and 6,554 (0.4%) participants, respectively. People having NWCO was associated with a greater risk for HF (hazard ratio (HR) 1.072, 95% confidence interval (CI) 1.026–1.119) and AF (HR 1.202, 95% CI 1.083–1.333) compared with those having normal-weight without CO. Conclusion Our analysis of a nationwide health check-up and administrative claims database including approximately 1.7 million participants without prevalent cardiovascular disease history demonstrated the potential impact of NWCO on the risk for HF and AF, suggesting the importance of abdominal obesity in the developing HF and AF even in normal-weight individuals.

Metabolic syndrome and cardiovascular disease in cancer survivors

“…We previously reported the pathological relationship between normal‐weight central obesity and the subsequent risk of developing CVD in the general population. 21 Our results showed that normal‐weight central obesity is also important in cancer survivors. Our findings would also imply a potential role for sarcopenic obesity, which has recently attracted clinical interest in CVD and cancer.…”

“… 24 It is also well established that WC is an important predictor of metabolic abnormalities and CVD development even after controlling for BMI. 21 , 25 , 26 Furthermore, the presence of abdominal obesity, even at normal weight, has been reported to increase the risk of developing CVD and CVD mortality. 21 , 23 , 26 BMI is difficult to distinguish between fat mass and skeletal muscle mass.…”

“… 21 , 25 , 26 Furthermore, the presence of abdominal obesity, even at normal weight, has been reported to increase the risk of developing CVD and CVD mortality. 21 , 23 , 26 BMI is difficult to distinguish between fat mass and skeletal muscle mass. Therefore, high WC, even at normal weight, may reflect excess visceral fat and low muscle mass (i.e., sarcopenic obesity), which may increase CVD risk.…”

Association of predicted body composition with occurrence of atrial fibrillation

“…It is well known that obesity, especially high levels of fat mass, worsens cardiovascular risk factors, including hypertension, lipoprotein metabolism, insulin resistance, and inflammation ( 9 , 10 ). Considering the association of obesity with AF, obesity is associated with an increase in AF ( 11 , 12 ). Therefore, it is important to develop an accurate method that measures obesity.…”

Central obesity as a potential causal risk factor for atrial fibrillation: evidence from Mendelian randomization study

“… 4 , 5 A recent study found that normal-weight central obesity was also a risk factor for AF. 6 As the evidence on this association is still limited, whether central obesity is independently associated with AF is not yet clear. Mendelian randomization (MR) is an approach that uses genetic variants associated with exposure as instrumental variables (IVs) to assess the causality of modifiable risk factors on disease and has been widely used in epidemiologic settings.…”