• Nazir Savji, Wouter C Meijers, Traci M Bartz, Vijeta Bhambhani, Mary Cushman, Matthew Nayor, Jorge R Kizer, Amy Sarma, Michael J Blaha, Ron T Gansevoort, Julius M Gardin, Hans L Hillege, Fei Ji, Willem J Kop, Emily S Lau, Douglas S Lee, Ruslan Sadreyev, Wiek H van Gilst, Thomas J Wang, Markella V Zanni, Ramachandran S Vasan, Norrina B Allen, Bruce M Psaty, Pim van der Harst, Daniel Levy, Martin Larson, Sanjiv J Shah, Rudolf A de Boer, John S Gottdiener, and Jennifer E Ho.
• Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
• JACC Heart Fail. 2018 Aug 1; 6 (8): 701-709.

ObjectivesThis study evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately.BackgroundRecent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear.MethodsWe studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models.ResultsThe mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI; 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18; 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34).ConclusionsObesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.Copyright © 2018 American College of Cardiology Foundation. All rights reserved.

29 keywords...

hide…