The Obesity and Heart Failure Epidemics Among African Americans: Insights From the Jackson Heart Study

Abstract

Background Higher rates of obesity and heart failure have been observed in African Americans, but associations with mortality are not well described. We examined intermediate-and long-term clinical implications of obesity in African Americans and associations between obesity and all-cause mortality, heart failure, and heart failure hospitalization. Methods and Results We conducted a retrospective analysis of a community sample of 5292 African Americans participating in the Jackson Heart Study between September 2000 and January 2013. The main outcomes were associations between BMI and all-cause mortality at 9 years and heart failure hospitalization at 7 years using Cox proportional hazards models and interval development of heart failure (median 8 years follow-up) using a modified Poisson model. At baseline, 1406 (27%) participants were obese and 1416 (27%) were morbidly obese. With increasing BMI, the cumulative incidence of mortality decreased (P = .007), whereas heart failure increased (P < .001). Heart failure hospitalization was more common among morbidly obese participants (9.0%; 95% CI, 7.6–11.7) than among normal-weight patients (6.3%; 95% CI, 4.7–8.4). After risk adjustment, BMI was not associated with mortality. Each 1-point increase in BMI was associated with a 5% increase in the risk of heart failure (HR, 1.05; 95% CI, 1.03–1.06; P < .001) and the risk of heart failure hospitalization for BMI greater than 32 kg/m2 (HR, 1.05; 95% CI, 1.03–1.07; P < .001). Conclusions Obesity and morbid obesity were common in a community sample of African Americans, and both were associated with increased heart failure and heart failure hospitalization.

Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

“…Moreover, these findings are consistent with Motala et al 66 , who found that the prevalence of metabolic risk factors was higher in rural South African females (25.0%) than in males (10.5%). Moreover, these findings somewhat reflect a gender-specific effect of metabolic risk factors discussed among African-American women precipitating diet-sensitive NCDs 67 – 69 . In several sub-Saharan African countries 46 , 70 , 71 , as well as in the African-American population 17 , 69 , the higher prevalence of metabolic risk factors in women compared to men has also been identified.…”

Association Between Food Insecurity and Key Metabolic Risk Factors for Diet-Sensitive Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

“…Moreover, these findings somewhat reflect a gender-specific effect of metabolic risk factors discussed among African-American women precipitating diet-sensitive NCDs. [55][56][57] In several sub-Saharan African countries 37,58,59 , as well as in the African-American population 15,57 , the higher prevalence of metabolic risk factors in women compared to men has also been identified. However, prevalence estimates from non-African American and other developed nations do not show a clear trend for gender variance in the prevalence of metabolic risk factors 53,57,60 .…”

Impact of Body Mass Index on Heart Failure by Race/Ethnicity From the Get With The Guidelines–Heart Failure (GWTG–HF) Registry

“…Considering the diverse racial composition of the U.S., the association of race/ethnicity on any BMI-HF mortality relationship becomes increasingly important. For example, African Americans (blacks) have the highest rates of both overweight/obesity and HF compared to other racial/ethnic groups in the U.S. (8) as well as increased HF and HF hospitalization rates (9) - factors likely significantly contributing to gaps in mortality and longevity by race/ethnicity. Additionally, as hospital readmissions are higher in blacks and Hispanics (10–13) and readmissions are closely linked to morbidity and mortality, it is imperative that BMI’s association with HF be characterized both in general and according to race/ethnicity to understand its effect on HF outcomes, and to potentially inform therapeutic interventions.…”