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Weight gain may affect heart structure, increase risk for HF
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Weight gain was associated with pathologic cardiac remodeling and an increased long-term risk for HF, according to new data from the Dallas Heart Study published in the Journal of the American Heart Association.
“Any weight gain may lead to abnormal changes in the heart above and beyond one's baseline weight,” Ian J. Neeland, MD, a cardiologist, assistant professor of medicine and Dedman Family Scholar in Clinical Care at University of Texas Southwestern Medical Center in Dallas and Cardiology Today Next Gen Innovator, said in an interview. “This means that prevention of HF should focus on weight loss or, if meaningful weight loss cannot be achieved, the focus should be on maintaining one's weight and preventing weight gain. Counseling to maintain weight stability may be an important preventive strategy among high-risk individuals.”
Bryan Wilner , MD , a third-year resident of internal medicine at the University of Texas Southwestern Medical Center, and colleagues reviewed data from 1,262 participants (mean age, 44 years; 57% women, 44% black; 36% obese) who did not have left ventricular dysfunction or CVD at baseline. Assessments that included measurements of cardiac structure, fat distributions and body compositions were initially taken from 2000 to 2002 and repeated from 2007 to 2008.
Outcome variables were change in LV end-diastolic volume and LV mass, LV wall thickness, concentricity index and LV ejection fraction.
At follow-up, 41% of participants had significant weight gain (> 5%), whereas 15% of participants lost a significant amount (> 5%) of weight. Increased weight gain was more likely to occur in participants who were younger, had fewer traditional risk factors and lower BMI at baseline (P < .05 for all).
Increased weight gain was linked to larger LV wall thickness (beta = 0.1; P < .0001), LV mass (beta = 0.1; P < .0001) and LV concentricity (beta = 0.07; P = .001) after adjusting for factors such as smoking, baseline age, sex, race, diabetes, hypertension, physical activity, alcohol use, the baseline cardiac variable and weight. The analyses also showed modest effects on LVEF (beta = 0.05; P = .0438) and LV end-diastolic volume (beta = 0.04; P = .0545). Other adiposity indices showed similar results.
“We are digging deeper into the body fat story to try and figure out if any weight gain has negative effects on the heart or if it is fat that gets stored in specific areas that make the biggest difference,” Neeland told Cardiology Today. “We are going to look at how different body fat locations play a role in cardiac structural and functional changes over time.” – by Darlene Dobkowski
For more information:
Ian J. Neeland, MD, can be reached at ian.neeland@utsouthwestern.edu.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Gregg C. Fonarow, MD, FACC, FAHA, FHFSA
A multitude of prior studies have demonstrated that obesity is an independent risk factor for developing HF in both women and men. Increases in weight and adiposity have been associated with pathologic ventricular remodeling, including increases in ventricular wall thickness, ventricular mass and mass-to-volume ratio.
This new study utilizes cardiac MRI to further evaluate the impact of weight gain in middle age and the impact on ventricular structure and function.
Consistent with prior studies, increases in BMI as well as central obesity were associated with concentric LV remodeling and related metrics. Important changes in ventricular structure and function were observed with a 5% increase in weight. Weight loss, without knowing if this was intentional or unintentional, was associated with decreases in ventricular mass.
As this type of ventricular remodeling is phenotypically related to HF, these findings suggest that these ventricular changes related to increasing adiposity in middle age may set the stage for a subsequent increased risk for clinical HF.
Further studies are needed to determine if intentional weight loss can reverse this ventricular remodeling and lower the subsequent risk for HF. Yet, prevention of these types of changes may be the best approach. Implementation of effective strategies to avoiding becoming overweight or obese in middle age are needed.
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