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. 2014 Dec;2(6):600-7.
doi: 10.1016/j.jchf.2014.05.017. Epub 2014 Oct 22.

Obesity, subclinical myocardial injury, and incident heart failure

Chiadi E Ndumele  1 , Josef Coresh  2 , Mariana Lazo  3 , Ron C Hoogeveen  4 , Roger S Blumenthal  5 , Aaron R Folsom  6 , Elizabeth Selvin  2 , Christie M Ballantyne  4 , Vijay Nambi  7
Affiliations

Obesity, subclinical myocardial injury, and incident heart failure

Chiadi E Ndumele et al. JACC Heart Fail. 2014 Dec.

Abstract

Objectives: The study sought to evaluate the association of obesity with a novel biomarker of subclinical myocardial injury, cardiac troponin T measured with a new high-sensitivity assay (hs-cTnT), among adults without clinical cardiovascular disease (CVD).

Background: Laboratory evidence suggests a relationship between obesity and myocardial injury that may play a role in the development of heart failure (HF), but there is limited clinical data regarding this association.

Methods: We evaluated 9,507 participants in the ARIC (Atherosclerosis Risk in Communities) study without baseline CVD (Visit 4, 1996 to 1999). We assessed the cross-sectional association of body mass index (BMI) with high (≥14 ng/l) and measurable (≥3 ng/l) hs-cTnT levels after multivariable regression. We further evaluated the independent and combined associations of BMI and hs-cTnT with incident HF.

Results: Higher BMI was independently associated with a positive, linear increase in the likelihood of high hs-cTnT, with severe obesity (BMI >35 kg/m(2)) associated with an odds ratio of 2.20 (95% confidence interval: 1.59 to 3.06) for high hs-cTnT after adjustment. Over 12 years of follow-up, there were 869 incident HF events. Obesity and hs-cTnT were both independently associated with incident HF, and individuals with severe obesity and high hs-cTnT had a greater than 9-fold higher risk of incident HF (hazard ratio: 9.20 [95% confidence interval: 5.67 to 14.93]) than individuals with normal weight and undetectable hs-cTnT.

Conclusions: Among individuals without CVD, higher BMI has an independent, linear association with subclinical myocardial injury, as assessed by hs-cTnT levels. Obesity and hs-cTnT provide independent and complementary prognostic information regarding the risk of incident HF.

Keywords: epidemiology; heart failure; obesity; troponin.

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Figures

Figure 1
Figure 1. Distribution of Cardiac Troponin T Detected with a Highly Sensitive Assay (hs-cTnT) in the ARIC Population without Clinical CVD, Stratified by BMI Category
Hs-cTnT levels are reported in ng/L
Figure 2
Figure 2. Cross-Sectional Association of BMI with High hs-cTnT Levels in Restricted Cubic Spline Model
Adjusted for age, sex, race, smoking status, DM, HTN, LDL-C, HDL-C, triglycerides, alcohol intake, NT-proBNP and estimated GFR
Figure 3
Figure 3. Adjusted Hazard Ratios for Incident HF Associated With Higher BMI Categories
Model 1: Adjusted for age Model 2: Adjusted for Model 1 variable plus sex, race, and smoking status Model 3: Adjusted for all variables in Model 2 variables plus DM, HTN, LDL-C, HDL-C, triglycerides, alcohol intake, NT-proBNP and estimated GFR
Figure 4
Figure 4. Combined Associations of BMI Categories and Hs-cTnT Levels with Risk of Incident HF
Adjusted for age, sex, race, smoking status, DM, HTN, LDL-C, HDL-C, triglycerides, alcohol intake, NT-proBNP and estimated GFR
See this image and copyright information in PMC

Comment in

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