Obesity and the Risk of Heart Failure

Kenchaiah, Satish; Evans, Jane C.; Levy, Daniel; Wilson, Peter W.F.; Benjamin, Emelia J.; Larson, Martin G.; Kannel, William B.; Vasan, Ramachandran S.

doi:10.1056/nejmoa020245

Cited by 2,533 publications

(1,095 citation statements)

References 30 publications

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“…Those factors are well known to predict incident cardiovascular disease,22, 23, 24 and our study uniquely demonstrated that the status of these factors at middle age would have prognostic value for prognosis after incident MI as well. In our study, healthy diet and physical activity at baseline were not individually associated with adverse outcomes after incident MI.…”

Section: Discussionsupporting

confidence: 61%

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Mok

Sang

Ballew

et al. 2018

JAHA

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BackgroundThe American Heart Association recommends focusing on 7 health factors (Life's Simple 7) for primordial prevention of cardiovascular health. However, whether greater adherence to Life's Simple 7 in midlife improves prognosis after myocardial infarction (MI) in later life is unknown.Methods and ResultsIn 1277 participants who developed MI during the ARIC (Atherosclerosis Risk in Communities) Study follow‐up, a 14‐point score of Life's Simple 7 was constructed according to the status (2 points for ideal, 1 point for intermediate, and 0 points for poor) of each of 7 factors (smoking, adiposity, physical activity, diet, total cholesterol, blood pressure, and fasting glucose) at baseline (1987–1989). Hazard ratios for composite and individual adverse outcomes of all‐cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke were calculated according to Life's Simple 7 score. During a median follow‐up of 3.3 years, 918 participants (72%) had subsequent adverse outcomes after MI. Life's Simple 7 score at middle age was inversely associated with adverse outcomes after MI (adjusted hazard ratios of composite outcome, 0.57 [95% confidence interval, 0.39–0.84] if score is ≥10, 0.78 [95% confidence interval, 0.57–1.07] if score is 7–9, and 0.82 [95% confidence interval, 0.60–1.11] if score is 4–6 versus ≤3). The association was largely independent of access to care and MI severity. Individual factors related to better prognosis after MI were ideal nonsmoking, body mass index, blood pressure, and fasting glucose.ConclusionsOptimal Life's Simple 7 at middle age was associated with better prognosis after MI in later life. Our findings suggest a secondary prevention benefit of having better cardiovascular health status in midlife.

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Section: Discussionsupporting

confidence: 61%

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Mok

Sang

Ballew

et al. 2018

JAHA

View full text Add to dashboard Cite

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“…Moreover, it is critical to note that these results do not negate the importance of BMI in standard risk prediction. Obesity is a well‐established marker of increased CVD risk,1 although these results suggest that it does not fully explain CVD risk. Ultimately, these results suggest that a “life‐course” approach to risk assessment that begins early and integrates BMI, known risk factors (eg, waist circumference), and metabolic risk will be critical in halting CVD progression.…”

Section: Discussionmentioning

confidence: 96%

“…Metabolic syndrome is a well‐established risk factor for cardiovascular disease (CVD), including coronary artery disease and heart failure 1. Alterations in metabolic risk linked to CVD may develop over decades before clinical CVD 2, 3, 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Murthy

Abbasi

Siddique

et al. 2016

JAHA

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BackgroundDespite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.Methods and ResultsIn 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a “metabolic” risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time‐dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low‐stable, low‐worsening, high‐stable, intermediate‐worsening, intermediate‐stable, and high‐worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher‐risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.ConclusionsTransitions in metabolic risk occur early in life. Obesity‐related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.

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“…An elevated body mass index (BMI; kg/m 2 ) is a recognized risk factor for new‐onset HFrEF and HFpEF 108, 109, 110, 111. Obesity has been associated with LVH and incipient LV dysfunction 112, 113.…”

Section: Obesity Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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Obesity and the Risk of Heart Failure

Abstract: In our large, community-based sample, increased body-mass index was associated with an increased risk of heart failure. Given the high prevalence of obesity in the United States, strategies to promote optimal body weight may reduce the population burden of heart failure.

Cited by 2,533 publications

References 30 publications

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

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