Relationship of normal-weight central obesity with the risk for heart failure and atrial fibrillation: analysis of a nationwide health check-up and claims database

Abstract

Aims: There have been scarce data on the relationship of normal-weight central obesity (NWCO) with the subsequent risk for heart failure (HF) and atrial fibrillation (AF). Using a nationwide health check-up and administrative claims database, we sought to clarify whether NWCO would be associated with the incidence of HF and AF.

Methods and results: Medical records of 1 697 903 participants without prior history of cardiovascular disease (CVD) and normal-weight (body mass index of 18.5-23.0 kg/m²) were extracted from the JMDC Claims Database, which is a health check-up and claims database. We defined NWCO as normal-weight and CO (waist circumference ≥ 90 cm for men or ≥ 80 cm for women). The median age was 44.0 (37.0-52.0) years and 872 578 (51.4%) participants were men. Overall, 154 778 individuals (9.1%) had CO. The mean follow-up period was 3.3 ± 2.6 years. Participants with NWCO were older and more likely to be women than those without. HF and AF occurred in 26 936 (1.6%) and 6554 (0.4%) participants, respectively. People having NWCO were associated with a greater risk for HF [hazard ratio (HR): 1.072, 95% confidence interval (CI) 1.026-1.119] and AF (HR: 1.202, 95% CI: 1.083-1.333) compared with those having normal-weight without CO.

Conclusion: Our analysis of a nationwide health check-up and administrative claims database including ∼1.7 million participants without prevalent CVD history demonstrated the potential impact of NWCO on the risk for HF and AF, suggesting the importance of abdominal obesity in the developing HF and AF even in normal-weight individuals.

Keywords: Atrial fibrillation; Heart failure; Normal-weight central obesity; Preventive cardiology.

Graphical Abstract

Figure 1

Flowchart. We extracted the data of 2 036 077 normal-weight individuals defined as body mass index of 18.5–23.0 kg/m² who were enrolled in the JMDC Claims Database between January 2005 and April 2020 and whose baseline health check-up data (including data on waist circumference) were available. Exclusion criteria were as follows: (i) age < 20 years (n = 3005); (ii) prior history of cardiovascular disease or renal failure (n = 71 086); and (iii) missing data on cigarette smoking (n = 105 528), and alcohol consumption (n = 158 555). Ultimately, we analyzed 1 697 903 participants in this study.

Figure 2

The frequency of events, corresponding incidence rates, and hazard ratios of normal-weight central obesity (defined as IDF-Asian) for cardiovascular disease events. The incidence rate was per 10 000 person-years. Cox regression analyses; Model 1 included normal-weight central obesity (unadjusted model); Model 2 included normal-weight central obesity, age, and sex; and Model 3 included normal-weight central obesity, age, sex, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, and alcohol consumption. IDF-Asian, International Diabetes Federation defined metabolic syndrome for Asians; NWCO, normal-weight central obesity.

Figure 3

Temporal changes in waist circumference and body mass index for development of heart failure and atrial fibrillation. We included 1 102 233 individuals who also had waist circumference and body mass index data 1 year after the initial health check-up available. We calculated HRs after adjusting for age, sex, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, alcohol consumption, and waist circumference and took into account the interaction term between baseline waist circumference and body mass index. HR, hazard ratio; CI, confidence interval.

Figure 4

Waist circumference and the risk of heart failure and atrial fibrillation. Cox regression analyses; Model 1 included waist circumference per 5 cm (unadjusted model); Model 2 included the hazard ratios of waist circumference per 5 cm adjusted for age and sex; and Model 3 included the hazard ratios of WC per 5 cm adjusted for age, sex, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, and alcohol consumption.

Figure 5

Restricted cubic spline. The relationship between waist circumference and the incidence of heart failure (overall) (A), heart failure (men) (B), heart failure (women) (C), atrial fibrillation (overall) (D), atrial fibrillation (men) (E), and atrial fibrillation (women) (F) was modelled using multivariable-adjusted spline regression models. We fitted three cubic spline models using three, four, and five knots, and the model with five knots was selected because it had the lowest Akaike’s information criterion. Hazard ratios and 95% confidence intervals for incident heart failure and atrial fibrillation were calculated for each waist circumference value. We calculated hazard ratios after adjusting for covariates including age, sex, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, and alcohol consumption. CI, confidence interval.

Figure 6

Subgroup analyses. Adjusted for age, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, and alcohol consumption in the subgroup analyses stratified by sex. Adjusted with age, sex, body mass index, hypertension, diabetes mellitus, dyslipidaemia, cigarette smoking, and alcohol consumption in the subgroup analyses stratified by age. HR, hazard ratio, CI, confidence interval.