202 - Obesity and Heart Failure: It's Not All About Size

Abstract

Introduction: Obesity is a traditionally accepted risk factor for heart failure (HF). Metabolic syndrome (MetS) often coexists with obesity and can confound risk calculation for HF having important implications on HF prevention strategies. Hypothesis: To identify the interaction and isolate the effects of MetS and obesity on incident HF risk assessment. Methods: Medical records of patients evaluated in the preventive cardiology clinic of a tertiary care hospital from 2006-14 were reviewed and data extracted. Obesity and MetS were described using BMI > 30 and National cholesterol education program (NCEP) ATP III criteria respectively. Patients with prior HF were excluded. Health-ABC score (HABCS), a well validated incident HF risk prediction score, with higher score equating higher risk, was calculated. Mean or median and percentage were reported for continuous and categorical variables respectively. HABCS was analyzed as an ordinal variable. Kruskall-Wallis test was used to compare HABCS and NT-proBNP among patient groups stratified according to body habitus and MetS. Dunn test was subsequently used to test for differences among all possible two group combinations. P < .05 was considered significant. Results: From this cohort (n = 4,154, mean age 62 ± 12 years, males 42%, NT-proBNP median [IQR] = 315 [179–877] pg/mL), 2,463 (60%) patients had BMI and MetS score calculated (mean age = 53.4 ± 13.3 years, males 40%, NT-proBNP median[IQR] = 66 [36–150] pg/mL). Among this cohort, MetS and obesity prevalence was 22% and 39% respectively. Median HABCS was higher for groups with obesity or MetS compared to those without. HABCS was higher in patients with concomitant obesity and MetS compared to obesity without MetS (P < .01). No difference in HABCS was present among patients with MetS with and without obesity (P = .3). Median NT-proBNP was highest in the group with concomitant obesity and MetS (median [IQR] = 79[40–213] (P < .01). Conclusions: Both obesity and MetS are associated with increased incident HF risk. However, in presence of concomitant MetS and obesity, MetS is a risk factor independent of obesity, evident by higher HABCS and median NT-proBNP, but not vice-versa. Greater attention should be given to diagnosis and management of MetS. Randomized controlled trials are needed for confirming these results.Table 1Baseline Characteristics of Study PopulationNon-obese no MetSNon-obese with MetSObese no MetSObese with MetSP valueN (2,463)1,342143575403Males (%)374873420.04SBP (mm Hg)121 + /−17137 + /−20125 + /−17136 + /−20<0.01DBP (mm Hg)74 + /−980 + /−1278 + /−1081 + /−10<0.01Creatinine (mg/dL)0.92 + /−0.50.93 + /−0.40.92 + /−0.50.86 + /−0.2<0.01NT-proBNP (IQR) pg/dL67 (39–144)56 (28–166)58 (31–130)79 (40–213)<0.01BMI (kg/m2)25 + /−327.4 + /−235 + /−536.6 + /−6<0.01HTN (%)46.760.84845.9<0.01DM (%)12.516.81312.1<0.01CAD (%)21.920.927.833.4<0.01Smoker (%)43.345.440.339.9<0.01Alcohol (%)59.362.954.449.6<0.01 Open table in a new tab