Adiposity and Incident Heart Failure and its Subtypes

Abstract

Objectives: To compare various measures of adiposity with risk for incident hospitalized heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). Background: Obesity is a risk factor for HF, particularly HFpEF. It is unknown which measures of adiposity, including anthropometrics and computed tomography (CT)-measured fat area, are most predictive of HF sub-types. Methods: We studied 1,806 participants of the Multi-Ethnic Study of Atherosclerosis without baseline cardiovascular disease (CVD) who underwent anthropometrics [Body Mass Index (BMI) and Waist Circumference (WC)] and an abdominal CT. Subcutaneous and visceral adipose tissue (SAT and VAT) were measured from a single CT slice at L2-L3. Cox hazard models were used to examine associations of adiposity with incident hospitalized HFpEF and HFrEF events. Fully-adjusted models included demographics, HF risk factors, and NT-proBNP Results: Over mean follow-up of 11 years, there were 34 HFpEF and 36 HFrEF events. The fully-adjusted Hazard Ratios (95% CI) per 1-SD higher of each anthropometric and CT-measured adiposity measures for incident HFpEF were as follows: BMI [1.66 (1.12–2.45)]; WC [1.59 (1.05–2.40)]; VAT [2.24 (1.44–3.49)]. None of these adiposity measures were associated with HFrEF. Even among overweight/obese adults (BMI≥25 kg/m2), assessment of VAT (per 1-SD) was strongly associated with HFpEF [2.78 (1.62–4.76)]. SAT was not associated with HFpEF nor HFrEF. Conclusions: In a multiethnic cohort free of CVD, CT-measured VAT was independently associated with incident hospitalized HFpEF but not HFrEF. Measuring visceral fat at the time of CT imaging for other indications may offer additional prognostication of HF risk.

Heart failure with mid-range or mildly reduced ejection fraction

“…The complex interaction between obesity and HF remains only partially understood. Obesity is a risk factor for HF but potentially more strongly so for HFpEF than for HFrEF 90 – 93 , whereas obesity has not been investigated specifically as a risk factor for HFrEF 86 . Secondary mitral regurgitation and right ventricular dysfunction have been reported to be less prevalent in HFmrEF and HFpEF than in HFrEF, whereas data on the epidemiology of secondary tricuspid regurgitation by EF phenotype are currently lacking 94 , 95 .…”

Metabolic syndrome and heart failure: mechanism and management

“…Visceral adiposity was found to be associated with a higher risk of developing HF in the black population in the Jackson heart study [ 12 ]. The finding was supported with the outcome of MESA study, a large multiethnic U.S. study, which found that visceral adiposity was independently associated with the incidence of hospitalized patients with heart failure preserved ejection fraction (HFpEF) [ 13 ].…”

Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

“…Consistently, studies have observed that risk of HF associated with VAT is driven by greater burden of cardiometabolic risk factors [ 5 , 33 ]. It is noteworthy that a more independent association between VAT and risk of HF has been reported, specifically with HF with preserved LVEF (HFpEF) [ 12 ]. Findings from our study suggest that the higher risk of HF, particularly HFpEF, in patients with higher amounts of VAT may be related to impairment in myocardial contractility independent of traditional CVD risk factors.…”

“…VAT has been associated with higher left ventricular (LV) mass and lower LV end diastolic volume (EDV) [ 5 , 9 ], while CRF has been associated with higher LV filling pressures and diastolic dysfunction [ 10 , 11 ]. These cardiac remodeling patterns may reflect intermediate phenotypes in the progression from at-risk to clinical HF [ 12 , 13 ].…”