Abstract 19477: Obesity is More Strongly Associated With Incident HFpEF than HFrEF: The Atherosclerosis Risk in Communities (ARIC) Study
Background: Obesity is associated with both diastolic and systolic dysfunction. However, it is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF) is the predominant form of HF associated with obesity in the population.
Hypothesis: We hypothesized that obesity is more strongly associated with incident HFpEF than incident HFrEF.
Methods: We followed 10,239 participants in ARIC, a community-based cohort, with body mass index (BMI) ≥18.5 kg/m2 and no CVD at baseline (Visit 4, 1996-99). We categorized BMI (kg/m2) as normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and severely obese (≥35). We constructed Cox regression models with successive adjustment for confounders (Model 1) and traditional CVD mediators (Model 2), to estimate the association of higher BMI with incident HFpEF and HFrEF during the period of ARIC HF adjudication (2005-2012). Seemingly unrelated regression, which is used to compare the magnitude of different risk associations within the same population, was used to compare coefficients for the associations of obesity with incident HFpEF and HFrEF.
Results: The mean age was 63 years (SD +/- 6), with 56% female and 22% black participants. Over a median follow-up of 8 years, there were 242 HFpEF and 257 HFrEF events. After adjustment for confounders (Table, Model 1), higher BMI was more strongly associated with incident HFpEF (HR for severe obesity 3.53; 95% CI: 2.32-5.36) than incident HFrEF (HR for severe obesity 1.93; 95% CI: 1.20-3.09) (p < 0.001 for comparison). In the fully adjusted model, obesity and severe obesity remained independently associated with incident HFpEF but not HFrEF (Table, Model 2).
Conclusions: Obesity was more strongly associated with incident HFpEF than HFrEF in this cohort. Given the limited therapeutic options for HFpEF, research efforts should focus on elucidating the pathways linking obesity to HFpEF and devising additional preventive strategies.
Author Disclosures: K. Sharma: None. K. Bernis: None. L. Kwak: None. K. Matsushita: None. A.M. Shah: None. L.R. Loehr: None. V. Nambi: None. R. Florido: None. P.P. Chang: None. S.D. Russell: None. C. Ballantyne: Consultant/Advisory Board; Modest; Abbott Diagnostics, Amarin, Amgen, Eli Lilly, Esperion, Ionis, Matinas BioPharma Inc, Novartis, Regeneron, Roche Diagnostic. Research Grant; Significant; NIH, AHA, ADA. Other Research Support; Significant; Abbott Diagnostic, Amarin, Amgen, Eli Lilly, Esperion, Ionis, Novartis, Pfizer, Regeneron, Roche Diagnostic, Sanofi-Synthelabo. Consultant/Advisory Board; Significant; Astra Zeneca, Merck, Pfizer, Sanofi-Synthelabo. J. Coresh: None. C.E. Ndumele: None. C.E. Ndumele: None.
- © 2016 by American Heart Association, Inc.