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BMI association with HF risk influenced by cardiorespiratory fitness
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Cardiorespiratory fitness largely explains the increased risk for HF with higher BMI, according to findings published in JACC: Heart Failure.
“Unfavorable lifestyle patterns are leading to increases in HF-related risk factors, contributing to the population burden of HF,” Ambarish Pandey, MD, cardiology fellow at the University of Texas Southwestern Medical Center, and colleagues wrote. “Consequently, novel HF prevention strategies are greatly needed.”
Pandey and colleagues followed participants (n = 19,485) of the Cooper Center Longitudinal Study who survived to receive Medicare coverage from 1999 to 2009. Participants’ BMI and cardiorespiratory fitness were measured at baseline. Follow-up continued until HF diagnosis or December 2009, whichever came first (median Medicare follow-up duration, 6.67 years).
During follow-up, 1,038 HF events were recorded.
With adjustment for age and sex, those with higher midlife BMI had an increased HF event rate after age 65 years (HR = 1.25 per 3 kg/m2 higher BMI; 95% CI, 1.17-1.32). Additionally, high-fit individuals (assessed through cardiorespiratory fitness) had a lower HF event rate.
When adjusted for cardiorespiratory fitness, the association of BMI with risk for HF was attenuated but remained significant (HR = 1.1 per 3 kg/m2 higher BMI; 95% CI, 1.03-1.17).
Established HF risk factors such as BP, diabetes, smoking status and cholesterol levels together accounted for 24% of the BMI-associated HF risk vs. 47% of the BMI association being explained by cardiorespiratory fitness.
In participants who had multiple BMI and cardiorespiratory fitness measurements (n = 8,683), a 1-kg/m2 increase in BMI was associated with a 8% higher risk for HF hospitalization after age 65 years, after adjustment for common risk factors. When adjusted for change in cardiorespiratory fitness, the association between BMI change and HF risk was no longer significant (HR = 1.05 per 1 kg/m2 BMI increase; 95% CI, 0.97-1.12).
“Given the burden of HF in the elderly, our observations could have important public health and research implications for HF prevention,” the researchers wrote. “The present study findings suggest that low [cardiorespiratory fitness] and higher BMI in midlife may identify individuals at increased risk of HF in older age.”
In an accompanying editorial, Carl J. Lavie, MD, FACC, FACP, FCCP, professor of medicine and medical director of cardiac rehabilitation and preventive cardiology and staff cardiologist at the John Ochsner Heart & Vascular Institute at the University of Queensland School of Medicine in New Orleans, and colleagues wrote: “Greater efforts to increase [cardiorespiratory fitness] in primary and secondary prevention are needed, which can be accomplished by regular [physical activity/exercise training]. An ideal way to accomplish this is through the use of cardiac rehabilitation and [exercise training] programs in CHD and HF; thus, it is very important to increase enrollment and adherence to these programs throughout the health care system in the U.S. and worldwide.” – by Cassie Homer
Disclosure: The researchers and editorial writers report no relevant financial disclosures.
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