Associations of Novel Indices of Adiposity with Incident Heart Failure

Abstract

Objective: To examine associations of newly-developed adiposity indices with incident heart failure (HF).Participants and Methods: The current study included 8493 adults from the PREVEND observational cohort (mean age: 49.8 years; 50% women). Exposures included novel adiposity indices i.e., relative fat mass (RFM), body-roundness index (BRI), weight-adjusted-waist index and body-shape index (BSI), as well as established adiposity indices i.e., body-mass index (BMI), waist circumference, and waist-hip ratio (WHR). Main outcome was development of incident HF.Results: The prevalence of overweight (BMI: 25-30kg/m2) and obesity (BMI≥30kg/m2) were 41% and 17% respectively. During 11.3±3.1 years of follow-up, 372 HF events were recorded, resulting in an overall HF incidence of 3.88 per 1000 person-years. All novel adiposity indices, except BSI, were significantly associated with incident HF (P<0.001). BMI, WC and WHR were also significantly associated with incident HF (P<0.001). Sex did not modify the association of any adiposity index with incident HF (Pint>0.1). Amongst adiposity indices, RFM displayed the strongest effect sizes (HR:1.67, 95%CI, 1.37-2.03). This trend persisted across multiple age categories, BMI categories and also among HF subtypes. All obesity measures, except BSI, improved the fit of the clinical HF model. Strongest improvement was observed after adding BRI and RFM (reduction in Akaike information criteria: 26.5 and 24.4 respectively).Conclusions: Relative fat mass is strongly associated with incident HF in the community. Future studies should examine the value of novel adiposity indices in HF risk estimation.

Underestimation of congestion in very obese heart failure with preserved ejection fraction patients: EAT your heart out…?!

“…First, in their study, BMI was used as a surrogate for obesity and adipose tissue, and those patients with higher BMI were considered to have more adipose tissue than those with lower BMI. BMI, however, does not reflect adipose tissue distribution and although BMI is widely used to assess obesity, there is consensus that other parameters of obesity, such as waist circumference and relative fat mass more accurately predict new onset HF 6 . Second, obese individuals are very likely to experience dyspnoea on exertion, and this is the case in both obese patient populations as well as in otherwise healthy obese individuals 7 .…”

“…BMI, however, does not reflect adipose tissue distribution and although BMI is widely used to assess obesity, there is consensus that other parameters of obesity, such as waist circumference and relative fat mass more accurately predict new onset HF. 6 Second, obese individuals are very likely to experience dyspnoea on exertion, and this is the case in both obese patient populations as well as in otherwise healthy obese individuals. 7 The increased prevalence of dyspnoea on exertion may cause inclusion bias with relative over inclusion of obese individuals, as compared to leaner individuals, as they experience higher symptom burden and may therefore be referred at earlier stages of disease.…”