Obesity appears to be significantly associated with incident HF, but not other subtypes of CVD, and this link persists after accounting for other known risk factors, according to recent findings.
Researchers analyzed 13,730 individuals with a BMI of at least 18.5 kg/m2 (range, 18-50; mean age, 54 years; 63.8% women; 16.9% black) and no baseline CVD who were enrolled in the ARIC study.
For the current study, data on covariates of interest, including BMI, smoking status, physical activity, alcohol consumption, diabetes, BP and lipid levels, were collected on visit 1, which occurred between 1987 and 1989. The outcomes of interest were incident HF, CHD and stroke. Participants were followed through 2012.
The researchers analyzed the associations of higher BMI with incident HF, CHD and stroke, both before and after adjustment for known CVD risk factors, including systolic BP, diabetes and lipid levels. Median follow-up was 23 years.
during follow-up, 2,235 HF events occurred, as well as 1,653 CHD events and 986 strokes.
Compared with normal weight, the incidence rate difference for severe obesity per 1,000 person-years was 12.1 for HF, 4 for CHD and 2.7 for stroke. The median time to incident HF was 15.7 years, whereas the median time to incident CHD was 12.7 years, and for stroke the median time was 13.7 years.
When the researchers adjusted for demographic characteristics, smoking, physical activity and alcohol consumption, they found that higher BMI was strongly associated with increased HRs for all subtypes of CVD, but that this association was strongest for incident HF. Severe obesity (BMI 35 kg/m2) had an HR of 3.74 (95% CI, 3.24-4.31) for HF, 2 (95% CI, 1.67-2.4) for CHD and 1.75 (95% CI, 1.3-2.2) for stroke. The risk coefficient for severe obesity and incident HF was greater than those for incident CHD and stroke (P < .0001 for both).
Although further adjustment for traditional CVD risk factors fully explained the links between higher BMI with CHD and stroke, it did not explain the association with HF (HR = 2.27; 95% CI, 1.94-2.64).
Likewise, the fully adjusted model revealed a 29% higher risk for incident HF for every 5-unit increase in BMI, whereas no significant associations were seen for CHD or stroke.
Chiadi Ndumele, MD, MHS, assistant professor of medicine at Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University School of Medicine, said these findings are a cause for concern, since obesity is not easily treated.
if my patients have normal blood sugar, cholesterol and [BP] levels, I believe I still have to worry that they may develop [HF] if they are severely obese,” Ndumele said in a press release. “If our data are confirmed, we need to improve our strategies for [HF] prevention in this population.” – by Jennifer Byrne
The researchers report no relevant financial disclosures.