Abstract
BackgroundWe aimed to investigate the hazard of hospitalization for heart failure (hHF) according to the transitions in metabolic health and obesity status.MethodsThe Korean National Health Insurance Service datasets from 2002 to 2017 were used for this nationwide, longitudinal, population-based study. The hazard of hHF was analyzed according to the eight groups stratified by stability in metabolic health and transition in obesity status among initially metabolically healthy adults who underwent two cycles of health examinations in 2009–2010 and 2013–2014 (N = 7,148,763).ResultsDuring two examinations, 48.43% of the initially metabolically healthy obese (MHO) individuals and 20.94% of the initially metabolically healthy non-obese (MHNO) individuals showed changes in their metabolic health and obesity status. During a mean follow-up of 3.70 years, 3151 individuals were hospitalized for HF. When stable MHNO individuals were set as the reference, transition to metabolically unhealthy phenotype was associated with an increased hazard of hHF; the hazard ratio (HR) and 95% confidence interval (CI) in the individuals who transformed from MHO to metabolically unhealthy non-obese was 2.033 (1.579–2.616). The constant MHO group had a 17.3% increased hazard of hHF compared with the stable MHNO group [HR (95% CI) 1.173 (1.039–1.325)]. Individuals who shifted from MHO to MHNO showed a 34.3% lower hazard of hHF compared with those who maintained the MHO category [HR (95% CI) 0.657 (0.508–0.849)].ConclusionDynamic changes in metabolic health and obesity status were observed during a relatively short interval of 3–5 years. Loss of metabolic health was significantly associated with an increased hazard of hHF. Even if metabolic health was maintained, persistent obesity remained as a risk factor for hHF, and transition from MHO to MHNO had a protective effect against hHF. Therefore, the prevention and control of obesity while maintaining metabolic health would be crucial in preventing hHF.
Highlights
We aimed to investigate the hazard of hospitalization for heart failure according to the transitions in metabolic health and obesity status
Among the participants who were metabolically healthy non-obese (MHNO) at the first examination, 4,284,989 (79.06%) remained in the same MHNO category at the second health examination, while 546,422 (10.08%) and 420,879 (7.77%) individuals transitioned to metabolically unhealthy non-obesity (MUNO) and metabolically healthy obese (MHO), respectively
The individuals who remained in the MHO category were associated with a 17.3% higher hazard of hospitalization for heart failure (hHF) compared with those who remained in the MHNO category
Summary
We aimed to investigate the hazard of hospitalization for heart failure (hHF) according to the transitions in metabolic health and obesity status. Due to the limitation in methods to reverse and cure HF, it is important to determine the risk factors for HF and identify individuals that are at an increased risk of developing HF, to establish an effective preventive strategy. Among 5881 patients in the Framingham Heart Study, HF risk increased by 5% in men and 7% in women according to each single unit increase in body mass index (BMI) after adjusting other known risk factors [5]. Most of the studies that investigated the association of obesity and overweight with HF used BMI to identify overweight and obese patients because of its practicality, but the reliability of BMI as an accurate measure of adiposity is still under debate [8]
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