Study highlights importance of diabetes for obesity-related HF risk
medwireNews: Higher BMI, waist circumference, and fat mass are each significantly associated with an increased risk for heart failure (HF) among older people with diabetes but not among those without diabetes, US researchers report.
Ambarish Pandey (University of Texas Southwestern Medical Center, Dallas) and colleagues say their findings suggest “that these measures of adiposity may be more relevant for downstream risk of HF in the presence of diabetes.”
The pooled analysis included individual-level data for 5495 members of the Atherosclerosis Risk in Communities (visit 5) cohort and 4892 participants of the Cardiovascular Health Study (visit 1) who had no history of HF at baseline and a median age of 74 years.
A quarter of participants had diabetes, 36.0% had prediabetes, 25.8% had overall obesity (BMI ≥30 kg/m2), and 55.9% had abdominal obesity (waist circumference >88 cm in women and >102 cm in men).
During 5 years of follow-up, 4.3% of participants developed HF, Pandey and co-authors report in Circulation.
On multivariate analysis they found that each standard deviation increase in BMI, waist circumference, and estimated fat mass was independently associated with a significantly increased risk for HF overall, at hazard ratios (HRs) of 1.19, 1.27, and 1.17, respectively.
However, the investigators note that the incidence of HF was higher in participants with versus without diabetes, at rates of 14.8 versus 7.5 events per 1000 person–years, and that there was a significant interaction between the three measures of adiposity and diabetes status with regards to HF risk.
Specifically, after adjustment for demographics and cardiovascular risk factors, the risk for HF in people with diabetes increased by a significant 1.29-fold, 1.48-fold, and 1.25-fold with each standard deviation increase in BMI, waist circumference, and estimated fat mass, respectively.
By contrast, there was no significantly increased risk for HF associated with adiposity among people without diabetes, including participants with prediabetes or euglycemia.
Furthermore, among the participants with diabetes, the population attributable risk percentage of overall obesity, abdominal obesity, and high fat mass (above sex-specific median) for incident HF was 12.8%, 29.9%, and 13.7%, respectively, whereas the corresponding values among people without diabetes were much lower, at 1.0%, 0.9%, and 0.5%.
Pandey et al conclude: “These findings highlight the contribution of diabetes to the adiposity-associated risk of HF.”
They add: “Future efforts should be directed at aggressive implementation of [sodium-glucose cotransporter 2 inhibitors] in individuals with diabetes and obesity at the highest risk of developing HF.”
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