Variability of adiposity indices and incident heart failure among adults with type 2 diabetes

Arnaud D Kaze,Prasanna Santhanam,Alain G Bertoni,Sebhat Erqou,Gregg C Fonarow,Rexford S Ahima,Justin B Echouffo-Tcheugui

doi:10.1186/s12933-021-01440-1

Abstract

BackgroundIt remains unclear how the variability of adiposity indices relates to incident HF. This study evaluated the associations of the variability in several adiposity indices with incident heart failure (HF) in individuals with type 2 diabetes (T2DM).MethodsWe included 4073 participants from the Look AHEAD (Action for Health in Diabetes) study. We assessed variability of body mass index (BMI), waist circumference (WC), and body weight across four annual visits using three variability metrics, the variability independent of the mean (VIM), coefficient of variation (CV), and intraindividual standard deviation (SD). Multivariable Cox regression models were used to generate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for incident HF.ResultsOver a median of 6.7 years, 120 participants developed incident HF. After adjusting for relevant confounders including baseline adiposity levels, the aHR for the highest (Q4) versus lowest quartile (Q1) of VIM of BMI was 3.61 (95% CI 1.91–6.80). The corresponding aHRs for CV and SD of BMI were 2.48 (95% CI 1.36–4.53) and 2.88 (1.52–5.46), respectively. Regarding WC variability, the equivalent aHRs were 1.90 (95% CI 1.11–3.26), 1.79 (95% CI 1.07–3.01), and 1.73 (1.01–2.95) for Q4 versus Q1 of VIM, CV and SD of WC, respectively.ConclusionsIn a large sample of adults with T2DM, a greater variability of adiposity indices was associated with higher risks of incident HF, independently of traditional risk factors and baseline adiposity levels.Registration-URL:https://clinicaltrials.gov/ct2/show/NCT00000620.

Highlights

It remains unclear how the variability of adiposity indices relates to incident heart failure (HF)
There is accruing evidence that body weight fluctuations are associated with increased risks of atherosclerotic cardiovascular disease (ASCVD) and deaths [11,12,13,14,15]; most studies have not explored the relation with incident HF, especially among people with T2DM
Using data from the Look AHEAD (Action for Health in Diabetes) study—a large cohort of adults with T2DM, we evaluated the associations of the variability in adiposity indices with incident HF events

Summary

Introduction

This study evaluated the associations of the variability in several adiposity indices with incident heart failure (HF) in individuals with type 2 diabetes (T2DM). Type 2 diabetes (T2DM), obesity and heart failure (HF) remain major public health problems across the USA [1,2,3] The interplay between these 3 entities is complex; with obesity increasing the risk of HF, and individuals with mild to moderate obesity having a better survival profile compared to those at the extreme adiposity levels [4]. There is accruing evidence that body weight fluctuations are associated with increased risks of atherosclerotic cardiovascular disease (ASCVD) and deaths [11,12,13,14,15]; most studies have not explored the relation with incident HF, especially among people with T2DM. To our knowledge, the association of variability in waist circumference (WC) with incident HF has never been assessed in T2DM

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Results

Discussion

Conclusion