Body Mass Index From Early‐, Mid‐, and Older‐Adulthood and Risk of Heart Failure and Atherosclerotic Cardiovascular Disease: MESA

Abstract

Background Obesity contributes significantly to risk of atherosclerotic cardiovascular disease (ASCVD) and especially for heart failure (HF). An elevated body mass index (BMI) in older adults might not carry the same risk as in younger adults, but measured weights at other lifetime points are often not available. We determined the associations of self‐reported weights from early‐ and mid‐adulthood, after accounting for measured weight at older age, with incident HF/ASCVD risk. Methods and Results We studied 6437 MESA (Multi‐Ethnic Study of Atherosclerosis) participants (aged 45–84, free of baseline HF/ASCVD) with self‐reported weights at ages 20 and 40 years (by questionnaire), measured weights at up to 5 in‐person examinations (2000–2012), and follow‐up for adjudicated HF/ASCVD events. Participant mean±SD age at the baseline examination was 62.2±10.2 years. Over median follow‐up of 13 years, 290 HF and 828 ASCVD events occurred. After adjustment for cardiovascular risk factors and baseline BMI, higher self‐reported weights at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (95% confidence interval) of 1.27 (1.07–1.50) and 1.36 (1.18–1.57), respectively, per 5‐kg/m 2 higher BMI. For incident ASCVD, only higher BMI at age 20 years was associated after accounting for current BMI (1.13 [1.01–1.26] per 5 kg/m 2 ). Obesity during follow‐up examinations was also associated with incident HF (1.72 [1.21–2.45]) but not ASCVD. Conclusions Self‐reported lifetime weight is a low‐tech tool easily utilized in any clinical encounter. Although subject to recall bias, self‐reported weights may provide prognostic information about future HF risk, incremental to current BMI, in a multiethnic cohort of middle‐aged to older adults. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00005487.

Is Belonging to a Religious Organization Enough? Differences in Religious Affiliation Versus Self-Ratings of Spirituality on Behavioral and Psychological Variables in Individuals with Heart Failure

“…Secondly, two-factor multivariate analysis of covariance (MANCOVA) and two-factor analysis of covariance (ANCOVA) were performed to determine if there were interactions between spirituality and religious affiliation. Age and body mass index (BMI) functioned as covariate due to the importance of BMI and age for HF patients [43]. When an interaction was significant, simple effect analyses were performed in lieu of main effects.…”

“…Each part consists of 20 descriptive assertions, and answers are given in a four-point Likert scale (1 = not at all to 4 = very much so). Scores of each part range from 20 to 80 points, and indicate either a low degree of anxiety (0-30), a moderate degree of anxiety (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), or a high degree of anxiety (equal to or over 50). The STAI has been used to study the relationship between anxiety and spirituality (e.g., [28]).…”

Regional adiposity and heart failure with preserved ejection fraction

“…4,9,10,23 The association of obesity and HFpEF also appears to be stronger among older African American women than compared to White women. 24 Additionally, higher body weights in young adulthood predicts incident HF independent of BMI later in life, 25 suggesting that cumulative lifetime BMI-years drives development of HF. Average BMI has increased across HFpEF trial cohorts, as shown in Figure 1.…”

Heart Failure and a Plant-Based Diet. A Case-Report and Literature Review

“…Increases in BMI are linearly associated with an increase in HF risk, where those with obesity having twice the risk of HF compared to those with a healthy BMI (88). Similarly, in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, greater self-reported weight at 20 and 40 years of age was associated with increased HF risk later in life (89).…”