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Obesity a risk factor for HFpEF in postmenopausal women
The prevalence of HF with preserved ejection fraction is increasing and findings from a new study suggest that obesity is a significant risk factor.
Researchers prospective evaluated 42,170 postmenopausal women who participated in the Women’s Health Initiative (51.2% white, 33.6% black, 15.2% Hispanic). The women were followed for an average of 13 years. The goal was to analyze risk factors for incident hospitalization for HF with preserved EF (HFpEF) compared with HF with reserved EF (HFrEF).
Overall, 1,952 women were hospitalized for acute incident HF. Of those, 46.2% met the definition of HFpEF and 26% met the definition of HFrEF; the remaining cases were determined to be of unknown EF. The researchers calculated an annualized incidence rate of 0.35% for incident hospitalized HF, 0.16% for HFpEF and 0.09% for HFrEF, according to the findings.
HFpEF and HFrEF were more common in white women compared with black and Hispanic women.
According to the findings, risk factors for incident hospitalized HFpEF and HFrEF included current smoking, diabetes, hypertension, interim MI, CHD and cancer, and older age. Risk factors for HFpEF only included history of CHD other than MI, hysterectomy, obesity and one or more comorbidities.
When the researchers examined differences in HFpEF by race/ethnicity, they found obesity was a stronger risk factor among black women compared with white women. Compared with a BMI < 25 kg/m2, a BMI of 30-34.9 kgm2 (HR = 6.27; 95% CI, 2.49-15.77) or 35 kg/m2 (HR = 7.5; 95% CI, 2.96-18.89) increased the risk for HFpEF among black women vs. white women (HR = 1.08; 95% CI, 0.81-1.43 and HR = 2.1; 95% CI, 1.57-2.8, respectively), according to the findings.
Among all postmenopausal women with HFpEF, the population-attributable risk percentage was 40.9% for hypertension and 25.8% for obesity; the highest population-attributable risk percentage occurred in black women.
“The importance of overweight and obesity in the potential prevention of HFpEF in women, especially in African American women, is noteworthy given its high [population-attributable risk percentage],” Charles B. Eaton, MD, MS, from the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, and colleagues wrote in the study. “Why overweight and obesity places African American women at higher risk for HFpEF compared with white women even when adjusting for diabetes mellitus and hypertension is unknown, but differences in inflammatory obesity, insulin sensitivity and visceral fat distribution might play a role in these findings.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.