Author + information
- Received September 19, 2013
- Revision received April 28, 2014
- Accepted May 2, 2014
- Published online December 1, 2014.
- Chiadi E. Ndumele, MD, MHS∗,†∗ (, )
- Josef Coresh, MD, PhD†,
- Mariana Lazo, MD, PhD, ScM†,‡,
- Ron C. Hoogeveen, PhD§,
- Roger S. Blumenthal, MD∗,
- Aaron R. Folsom, MD, MPH‖,
- Elizabeth Selvin, PhD, MPH†,
- Christie M. Ballantyne, MD§ and
- Vijay Nambi, MD, PhD§,¶
- ∗Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- ‡Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- §Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
- ‖Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
- ¶Michael E DeBakey Veterans Affairs Hospital, Houston Texas
- ↵∗Reprint requests and correspondence:
Dr. Chiadi E. Ndumele, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 North Wolfe Street, Carnegie 568, Baltimore, Maryland 21287.
Objectives The study sought to evaluate the association of obesity with a novel biomarker of subclinical myocardial injury, cardiac troponin T measured with a new high-sensitivity assay (hs-cTnT), among adults without clinical cardiovascular disease (CVD).
Background Laboratory evidence suggests a relationship between obesity and myocardial injury that may play a role in the development of heart failure (HF), but there is limited clinical data regarding this association.
Methods We evaluated 9,507 participants in the ARIC (Atherosclerosis Risk in Communities) study without baseline CVD (Visit 4, 1996 to 1999). We assessed the cross-sectional association of body mass index (BMI) with high (≥14 ng/l) and measurable (≥3 ng/l) hs-cTnT levels after multivariable regression. We further evaluated the independent and combined associations of BMI and hs-cTnT with incident HF.
Results Higher BMI was independently associated with a positive, linear increase in the likelihood of high hs-cTnT, with severe obesity (BMI >35 kg/m2) associated with an odds ratio of 2.20 (95% confidence interval: 1.59 to 3.06) for high hs-cTnT after adjustment. Over 12 years of follow-up, there were 869 incident HF events. Obesity and hs-cTnT were both independently associated with incident HF, and individuals with severe obesity and high hs-cTnT had a greater than 9-fold higher risk of incident HF (hazard ratio: 9.20 [95% confidence interval: 5.67 to 14.93]) than individuals with normal weight and undetectable hs-cTnT.
Conclusions Among individuals without CVD, higher BMI has an independent, linear association with subclinical myocardial injury, as assessed by hs-cTnT levels. Obesity and hs-cTnT provide independent and complementary prognostic information regarding the risk of incident HF.
The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). The views expressed in this article are those of the authors and do not represent the views of the Department of Veterans Affairs. This work was supported by the Robert E. Meyerhoff Professorship, the PJ Schafer Memorial Fund, and an Investigator Research Supplement from the National Heart, Lung and Blood Institute awarded to Dr. Ndumele, and by a National Heart, Lung and Blood Institute grant (5K23HL096893) awarded to Dr. Nambi. Drs. Hoogeveen, Ballantyne, Nambi and along with Roche and Baylor College of Medicine have filed a provisional patent (patent #61721475) entitled “Biomarkers to Improve Prediction of Heart Failure Risk.” Dr. Hoogeveen has received research grant support from Roche. Dr. Nambi has carried out research in collaboration with GE and Tomtec. All other authors have confirmed that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2013.
- Revision received April 28, 2014.
- Accepted May 2, 2014.
- American College of Cardiology Foundation