Abstract 13754: Association of Cumulative Excess Adiposity With Heart Failure With Preserved and Reduced Ejection Fraction: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Prior studies suggest that obesity, measured at a single time point, has a stronger association with heart failure with preserved ejection fraction (HFpEF) than heart failure with reduced ejection fraction (HFrEF). Longstanding obesity is associated with both diastolic and systolic dysfunction, but there is scarce data on the association of cumulative adiposity with risks for HFpEF and HFrEF. Hypothesis: Higher cumulative adiposity is associated with increased risk for both HFpEF and HFrEF. Methods: We performed a prospective analysis of 8,895 individuals (mean age 63, 57% women, 19% Black adults) without HF or coronary heart disease (CHD) who attended ARIC Visit 4 (1996-99). We calculated cumulative excess body-mass index (BMI) years from age 25 to Visit 4 by centering the BMI variable at 25 kg/m2 at each of the first 4 ARIC visits and at age 25 (self-reported), and multiplying the average BMI by the number of years from age 25 to Visit 4. Cumulative excess BMI years were categorized into quartiles. The outcomes were cases of incident HFpEF (EF ≥50%) and HFrEF (EF <50%) during the period of HF adjudication in ARIC (1/1/2005-12/31/2019); we excluded those with HF prior to 2005. We used Cox models to calculate incidence rates and estimate hazard ratios (HRs) for the associations of cumulative excess BMI years with incident HFpEF and HFrEF, adjusting for covariates including incident CHD. Results: There were 554 HFpEF and 482 HFrEF events over 14 years of follow-up. Higher quartiles of cumulative excess BMI years were associated with greater incidence of HFpEF and HFrEF (Table). Compared to the lowest quartile, the highest quartile of cumulative excess BMI years was associated with greater risk for HFpEF (HR: 1.57, 95% CI 1.22-2.03) and HFrEF (1.50, 95% CI 1.13-1.99). Conclusions: Excess cumulative weight is associated with similarly increased risks of HFpEF and HFrEF, indicating the importance of obesity prevention for reducing the risks for different subtypes of HF.