The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

Nazir Savji, Wouter C. Meijers, Traci M. Bartz, Vijeta Bhambhani, Mary Cushman, Matthew Nayor, Jorge Kizer, Amy Sarma, Michael J. Blaha, Ron T. Gansevoort, Julius M. Gardin, Hans L. Hillege, Fei Ji, Willem J. Kop, Emily S. Lau, Douglas S. Lee, Ruslan Sadreyev, Wiek H. van Gilst, Thomas J. Wang, Markella V. ZanniRamachandran S. Vasan, Norrina B. Allen, Bruce M. Psaty, Pim van der Harst, Daniel Levy, Martin Larson, Sanjiv J. Shah, Rudolf A. de Boer, John S. Gottdiener, Jennifer E. Ho

Research output: Contribution to journalArticle

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Abstract

Objectives: The authors evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. Background: Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. Methods: We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. Results: The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI, 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18, 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). Conclusions: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.

Original languageEnglish (US)
JournalJACC: Heart Failure
DOIs
StateAccepted/In press - Jan 1 2018

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Body Mass Index
Obesity
Confidence Intervals
Insulin Resistance
Sex Characteristics
Proportional Hazards Models
Heart Failure

Keywords

  • heart failure
  • HFpEF
  • insulin resistance
  • obesity
  • sex differences

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Savji, N., Meijers, W. C., Bartz, T. M., Bhambhani, V., Cushman, M., Nayor, M., ... Ho, J. E. (Accepted/In press). The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF. JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2018.05.018

The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF. / Savji, Nazir; Meijers, Wouter C.; Bartz, Traci M.; Bhambhani, Vijeta; Cushman, Mary; Nayor, Matthew; Kizer, Jorge; Sarma, Amy; Blaha, Michael J.; Gansevoort, Ron T.; Gardin, Julius M.; Hillege, Hans L.; Ji, Fei; Kop, Willem J.; Lau, Emily S.; Lee, Douglas S.; Sadreyev, Ruslan; van Gilst, Wiek H.; Wang, Thomas J.; Zanni, Markella V.; Vasan, Ramachandran S.; Allen, Norrina B.; Psaty, Bruce M.; van der Harst, Pim; Levy, Daniel; Larson, Martin; Shah, Sanjiv J.; de Boer, Rudolf A.; Gottdiener, John S.; Ho, Jennifer E.

In: JACC: Heart Failure, 01.01.2018.

Research output: Contribution to journalArticle

Savji, N, Meijers, WC, Bartz, TM, Bhambhani, V, Cushman, M, Nayor, M, Kizer, J, Sarma, A, Blaha, MJ, Gansevoort, RT, Gardin, JM, Hillege, HL, Ji, F, Kop, WJ, Lau, ES, Lee, DS, Sadreyev, R, van Gilst, WH, Wang, TJ, Zanni, MV, Vasan, RS, Allen, NB, Psaty, BM, van der Harst, P, Levy, D, Larson, M, Shah, SJ, de Boer, RA, Gottdiener, JS & Ho, JE 2018, 'The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF', JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2018.05.018
Savji, Nazir ; Meijers, Wouter C. ; Bartz, Traci M. ; Bhambhani, Vijeta ; Cushman, Mary ; Nayor, Matthew ; Kizer, Jorge ; Sarma, Amy ; Blaha, Michael J. ; Gansevoort, Ron T. ; Gardin, Julius M. ; Hillege, Hans L. ; Ji, Fei ; Kop, Willem J. ; Lau, Emily S. ; Lee, Douglas S. ; Sadreyev, Ruslan ; van Gilst, Wiek H. ; Wang, Thomas J. ; Zanni, Markella V. ; Vasan, Ramachandran S. ; Allen, Norrina B. ; Psaty, Bruce M. ; van der Harst, Pim ; Levy, Daniel ; Larson, Martin ; Shah, Sanjiv J. ; de Boer, Rudolf A. ; Gottdiener, John S. ; Ho, Jennifer E. / The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF. In: JACC: Heart Failure. 2018.
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abstract = "Objectives: The authors evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. Background: Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. Methods: We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50{\%} vs. <50{\%}). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. Results: The mean age was 60 ± 13 years, and 53{\%} were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI, 95{\%} confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18, 95{\%} CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95{\%} CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95{\%} CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). Conclusions: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.",
keywords = "heart failure, HFpEF, insulin resistance, obesity, sex differences",
author = "Nazir Savji and Meijers, {Wouter C.} and Bartz, {Traci M.} and Vijeta Bhambhani and Mary Cushman and Matthew Nayor and Jorge Kizer and Amy Sarma and Blaha, {Michael J.} and Gansevoort, {Ron T.} and Gardin, {Julius M.} and Hillege, {Hans L.} and Fei Ji and Kop, {Willem J.} and Lau, {Emily S.} and Lee, {Douglas S.} and Ruslan Sadreyev and {van Gilst}, {Wiek H.} and Wang, {Thomas J.} and Zanni, {Markella V.} and Vasan, {Ramachandran S.} and Allen, {Norrina B.} and Psaty, {Bruce M.} and {van der Harst}, Pim and Daniel Levy and Martin Larson and Shah, {Sanjiv J.} and {de Boer}, {Rudolf A.} and Gottdiener, {John S.} and Ho, {Jennifer E.}",
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T1 - The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF

AU - Savji, Nazir

AU - Meijers, Wouter C.

AU - Bartz, Traci M.

AU - Bhambhani, Vijeta

AU - Cushman, Mary

AU - Nayor, Matthew

AU - Kizer, Jorge

AU - Sarma, Amy

AU - Blaha, Michael J.

AU - Gansevoort, Ron T.

AU - Gardin, Julius M.

AU - Hillege, Hans L.

AU - Ji, Fei

AU - Kop, Willem J.

AU - Lau, Emily S.

AU - Lee, Douglas S.

AU - Sadreyev, Ruslan

AU - van Gilst, Wiek H.

AU - Wang, Thomas J.

AU - Zanni, Markella V.

AU - Vasan, Ramachandran S.

AU - Allen, Norrina B.

AU - Psaty, Bruce M.

AU - van der Harst, Pim

AU - Levy, Daniel

AU - Larson, Martin

AU - Shah, Sanjiv J.

AU - de Boer, Rudolf A.

AU - Gottdiener, John S.

AU - Ho, Jennifer E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: The authors evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. Background: Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. Methods: We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. Results: The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI, 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18, 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). Conclusions: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.

AB - Objectives: The authors evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. Background: Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. Methods: We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. Results: The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI, 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18, 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). Conclusions: Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.

KW - heart failure

KW - HFpEF

KW - insulin resistance

KW - obesity

KW - sex differences

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