Hospitalization for heart failure incidence according to the transition in metabolic health and obesity status: a nationwide population-based study

Abstract

Background: We aimed to investigate the hazard of hospitalization for heart failure (hHF) according to the transitions in metabolic health and obesity status. Methods: The Korean National Health Insurance Service datasets from 2002 to 2017 were used for this nationwide, longitudinal, population-based study. The hazard of hHF was analyzed according to the eight groups stratified by stability in metabolic health and transition in obesity status among initially metabolically healthy adults who underwent two cycles of health examinations in 2009-2010 and 2013-2014 (N = 7,148,763). Results: During two examinations, 48.43% of the initially metabolically healthy obese (MHO) individuals and 20.94% of the initially metabolically healthy non-obese (MHNO) individuals showed changes in their metabolic health and obesity status. During a mean follow-up of 3.70 years, 3151 individuals were hospitalized for HF. When stable MHNO individuals were set as the reference, transition to metabolically unhealthy phenotype was associated with an increased hazard of hHF; the hazard ratio (HR) and 95% confidence interval (CI) in the individuals who transformed from MHO to metabolically unhealthy non-obese was 2.033 (1.579-2.616). The constant MHO group had a 17.3% increased hazard of hHF compared with the stable MHNO group [HR (95% CI) 1.173 (1.039-1.325)]. Individuals who shifted from MHO to MHNO showed a 34.3% lower hazard of hHF compared with those who maintained the MHO category [HR (95% CI) 0.657 (0.508-0.849)]. Conclusion: Dynamic changes in metabolic health and obesity status were observed during a relatively short interval of 3-5 years. Loss of metabolic health was significantly associated with an increased hazard of hHF. Even if metabolic health was maintained, persistent obesity remained as a risk factor for hHF, and transition from MHO to MHNO had a protective effect against hHF. Therefore, the prevention and control of obesity while maintaining metabolic health would be crucial in preventing hHF.

Metabolically Healthy and Unhealthy Normal Weight and Obesity

“…When compared to stable MHNO individuals, subjects who retained MHO during a mean follow-up of 3.70 years, had a 17.3% increased hazard of hospitalization for heart failure (hHF). Furthermore, individuals who shifted from MHO to MHNO had a 34.3% lower hazard of hHF [33]. This is in agreement with previous observations showing that subjects with MHO may have no or only a moderately increased risk of myocardial infarction, but are not protected from heart failure [34], which is also strongly driven by obesity [35,36].…”

“…While subjects with transient MHO had an increased risk (152%) of a composite subclinical atherosclerosis endpoint, the risk was statistically not different (8%) in subjects with stable MHO, when compared to subjects who were metabolically healthy and non-obese (MHNO) [32]. Of interest, persistent MH in obesity does not protect from heart failure as was most recently shown in an analysis of data from the Korean NHIS datasets from 2002 to 2017 [33]. When compared to stable MHNO individuals, subjects who retained MHO during a mean follow-up of 3.70 years, had a 17.3% increased hazard of hospitalization for heart failure (hHF).…”

“…Of interest, persistent MH in obesity does not protect from heart failure as was most recently shown in an analysis of data from the Korean NHIS datasets from 2002 to 2017 [ 33 ]. When compared to stable MHNO individuals, subjects who retained MHO during a mean follow-up of 3.70 years, had a 17.3% increased hazard of hospitalization for heart failure (hHF).…”

Differential Effect of Metabolic Health and Obesity on Incident Heart Failure: A Nationwide Population-Based Cohort Study

“…One previous study followed patients with metabolic syndrome for 6 years and revealed that they were at 2.3, 2.6, and 2.1 (normal weight, overweight, and obese, respectively) times higher risk of developing HF than those without metabolic syndrome (34). Another recent longitudinal study revealed that the hospitalization for HF was increased in obese subjects who transitioned from metabolically healthy to unhealthy status (37). Among individuals without metabolic syndrome, obese individuals were at a higher risk of hospitalization for HF than non-obese individuals (37).…”

“…Another recent longitudinal study revealed that the hospitalization for HF was increased in obese subjects who transitioned from metabolically healthy to unhealthy status (37). Among individuals without metabolic syndrome, obese individuals were at a higher risk of hospitalization for HF than non-obese individuals (37). The two previous studies classified patients according to their metabolic syndrome, which indicates meeting three or more of the five criteria, including waist circumference, BP, fasting TG level, fasting HDL-C, and FPG levels (38).…”