Abstract 19852: The Relationship Between Obesity and Heart Failure is Stronger than Those for Other CVD Subtypes and Not Explained by Traditional Risk Factors

Abstract

Background: Although obesity is a risk factor for various subtypes of cardiovascular disease (CVD), the mechanisms responsible for these relationships likely differ. Limited studies have prospectively compared the associations between obesity and CVD subtypes within the same population. Hypothesis: We hypothesized that the association of obesity with heart failure (HF) is stronger than those with other subtypes of CVD, and not fully explained by traditional risk factors. Methods: We followed 13,730 ARIC participants without CVD at baseline (1987-1989) and with body mass index (BMI) ≥18.5 kg/m2. BMI (kg/m2) was categorized as normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and severely obese (≥35). Participants were followed prospectively for incident HF, coronary heart disease (CHD), and stroke. Cox regression models with adjustment for demographic and traditional CVD risk factors were constructed to estimate the associations between BMI and CVD subtypes. Seemingly unrelated regression was used to compare coefficients for the different risk associations, to account for correlations in the error terms. Results: The mean age was 54 years (SD +/- 6) and 56% were female. Over a median follow-up of 23 years, there were 2,090 HF events, 1,577 CHD events, and 948 strokes. Incident HF demonstrated the highest hazard ratios in association with higher BMI among CVD subtypes in all models, and was the only CVD subtype demonstrating significant associations with higher BMI categories in the fully adjusted model (Table). Indeed, in the fully adjusted model, the risk coefficient between severe obesity and HF was significantly greater than those for CHD and stroke (both p<0.0001). Conclusions: The relationship between obesity and HF was stronger than those for other CVD subtypes, and was not explained by traditional risk factors. Research efforts should focus on elucidating non-traditional pathways linking obesity to HF and devising novel preventive strategies.