Body Mass Index, Abdominal Fatness and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies
Background—Obesity has been associated with increased risk of heart failure, however, whether overweight also increases risk is unclear. It is unclear whether abdominal adiposity is more strongly associated with heart failure risk than general adiposity. We conducted a systematic review and meta-analysis of prospective studies with an aim to clarify the strength and shape of the dose-response relationship between general and abdominal adiposity and the risk of heart failure.
Methods and Results—PubMed and Embase databases were searched up to October 10th 2014. Summary relative risks (RRs) were calculated using random effects models. A total of 28 studies (27 publications) were included. Twenty-three prospective studies with >15905 incident cases among 647388 participants were included in the analysis of BMI and heart failure incidence and four studies were included for heart failure mortality. The summary relative risk for a 5 unit increment in BMI was 1.41 (95% confidence interval: 1.34-1.47, I2=83%) for heart failure incidence and 1.26 (95% CI: 0.85-1.87, I2=95%) heart failure mortality. Although the test for nonlinearity was significant, p<0.0001, this appeared to be due to a threshold at around a BMI of 23-24, however, there was evidence of increased risk even in the overweight BMI range. The summary RR for a 10 cm increase in waist circumference was 1.29 (95% CI: 1.21-1.37, I2=89%) and per 0.1 unit increase in waist-to-hip ratio was 1.29 (95% CI: 1.13-1.47, I2=82%).
Conclusions—Overweight and obesity, as well as abdominal adiposity, is associated with increased risk of heart failure.
- Waist circumference
- Waist-to-hip ratio
- heart failure
- observational studies
- systematic review
- Received April 1, 2015.
- Revision received November 17, 2015.
- Accepted December 29, 2015.