Obesity tied to elevated HF risk in patients with diabetes
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Among older adults, three measures of adiposity conferred elevated risk for HF in patients with diabetes but not in those without diabetes, according to data published in Circulation.
“Obesity affects over one-third of adults in the United States and is a significant risk factor for diabetes and HF,” Kershaw V. Patel, MD, preventive cardiologist at Houston Methodist DeBakey Heart and Vascular Center, and colleagues wrote. “Several factors contribute to the obesity-associated risk of CVD, particularly HF, including the higher downstream burden of CVD risk factors and direct effects of higher BMI on cardiac structure and function. However, BMI — the standard metric used for assessing obesity — does not adequately capture the heterogeneity of adiposity and regional adiposity measures.
“Based on prior study findings examining the relationships among anthropometric measures of adiposity with risk of HF across different study populations, we hypothesized that these anthropometric measures would be significantly associated with a greater risk of HF, particularly among those with diabetes,” the researchers wrote.
Researchers pooled data from 10,387 participants from the Atherosclerosis Risk in Communities (ARIC) study and Cardiovascular Health Study (CHS) cohorts for the present analysis (25.1% with diabetes; median age, 74 years), excluding individuals with prevalent HF, to evaluate the relationship between BMI, waist circumference and fat mass with risk for HF and among those with and without diabetes at baseline.
Obesity and HF risk
During 5 years of follow-up, 4.3% of the study population developed HF.
Greater levels of BMI, waist circumference and fat mass were associated with greater risk for HF:
- HR per 1 standard deviation (SD) higher BMI = 1.19; 95% CI, 1.09-1.31;
- HR per 1 SD higher waist circumference = 1.27; 95% CI, 1.14-1.41; and
- HR per 1 SD higher fat mass = 1.17; 95% CI, 1.06-1.29.
Obesity plus diabetes and HF
Researchers observed an interaction between baseline diabetes status and measures of BMI (P for interaction = .04) and waist circumference (P for interaction = .004) for the risk for HF.
Moreover, greater levels of BMI, waist circumference and fat mass were associated with greater risk for HF among patients with diabetes at baseline compared with those without diabetes, including participants with prediabetes and euglycemia:
- HR per 1 SD higher BMI = 1.29; 95% CI, 1.14-1.47;
- HR per 1 SD higher waist circumference = 1.48; 95% CI, 1.29-1.7; and
- HR per 1 SD higher fat mass = 1.25; 95% CI, 1.09-1.43.
According to the study, among patients with diabetes, the population-attributable risk percentage for incident HF was 12.8% for overall obesity, 29.9% for abdominal obesity and 13.7% for high fat mass, whereas for with those without diabetes, the population-attributable risk percentage for HF was 1% or less for each adiposity measure.
“Among older adults, higher levels of BMI, waist circumference and fat mass are each associated with higher risk of heart failure especially those with diabetes,” Patel told Healio. “In the patient population with obesity, individuals who also have diabetes are at high risk for developing HF. Patients with both obesity and diabetes are likely to benefit from effective preventive therapies.”
For more information:
Kershaw V. Patel, MD, can be reached at kvpatel@houstonmethodist.org.
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