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. 2018 Aug;6(8):701-709.
doi: 10.1016/j.jchf.2018.05.018. Epub 2018 Jul 11.

The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

Nazir Savji  1 , Wouter C Meijers  2 , Traci M Bartz  3 , Vijeta Bhambhani  4 , Mary Cushman  5 , Matthew Nayor  1 , Jorge R Kizer  6 , Amy Sarma  1 , Michael J Blaha  7 , Ron T Gansevoort  2 , Julius M Gardin  8 , Hans L Hillege  2 , Fei Ji  9 , Willem J Kop  10 , Emily S Lau  1 , Douglas S Lee  11 , Ruslan Sadreyev  9 , Wiek H van Gilst  2 , Thomas J Wang  12 , Markella V Zanni  13 , Ramachandran S Vasan  14 , Norrina B Allen  15 , Bruce M Psaty  16 , Pim van der Harst  2 , Daniel Levy  17 , Martin Larson  18 , Sanjiv J Shah  19 , Rudolf A de Boer  2 , John S Gottdiener  20 , Jennifer E Ho  21
Affiliations

The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

Nazir Savji et al. JACC Heart Fail. 2018 Aug.

Abstract

Objectives: This study evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately.

Background: Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear.

Methods: We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models.

Results: The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI; 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18; 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34).

Conclusions: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.

Keywords: HFpEF; heart failure; insulin resistance; obesity; sex differences.

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Figures

Figure 1
Figure 1
Cumulative incidence of (A) HFpEF and (B) HFrEF in men and women with and without obesity.
Figure 2
Figure 2
Risk of HFpEF or HFrEF in women and men across quartiles of BMI. P-values represent P for trend.
See this image and copyright information in PMC

Comment in

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