Abstract 4038: Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship with Obesity in The Multi-Ethnic Study of Atherosclerosis (MESA)
Background: We studied the association of metabolic syndrome (MetSyn) and novel metabolic risk factors (systemic inflammation, insulin resistance, and albuminuria) with incident symptomatic CHF in a multi-ethnic cohort. We also explored if the association of obesity with CHF is partially explained by novel risk factors.
Methods: Multi-Ethnic Study of Atherosclerosis is a cohort study of 6,814 participants (aged 45– 84 years) recruited between 2000 and 2002 from 6 US communities. Individuals with a history of clinically apparent cardiovascular disease were excluded at baseline. Cox proportional hazards models were used to analyze the association of MetSyn (defined by ATP III criteria) and novel risk factors with incident CHF independently of established risk factors (age, gender, hypertension, diabetes, left ventricular [LV] hypertrophy, obesity, serum cholesterol, and smoking) and LV function at baseline.
Results: Seventy nine participants developed symptomatic CHF during a median follow-up time of 4 years. African Americans had the highest incidence of CHF, followed by Hispanics, Caucasians, and Chinese (4.6, 3.5, 2.4, and 1.0 in 1000 person-years, respectively). MetSyn was observed in 2,362 participants (34.7%) at baseline. Table 1⇓ summarizes the results of unadjusted and adjusted models. In multivariable analysis including novel and established risk factors and LV function (not shown in Table 1⇓), serum IL−6 (hazard ratio [HR],1.50, 95% confidence interval [CI] 1.10–2.03) or CRP ((HR, 1.38; 95% CI 1.01–1.86) and macroalbuminuria (HR, 4.31, 95% CI 1.58–11.76) were independent predictors of CHF. Obesity was significantly associated with both CHF and inflammatory markers, but the association of obesity with CHF was not significant in the models including IL−6 or CRP.
Conclusions: Inflammatory markers and albuminuria are independent predictors of CHF. The association of obesity and CHF may be partially mediated by pathways related to inflammation.