Author + information
- Received September 12, 2016
- Revision received December 26, 2016
- Accepted December 28, 2016
- Published online April 5, 2017.
- Ambarish Pandey, MDa,
- William K. Cornwell III, MDb,
- Benjamin Willis, MDc,
- Ian J. Neeland, MDa,
- Ang Gao, MSd,
- David Leonard, PhDc,
- Laura DeFina, MDc and
- Jarett D. Berry, MD, MSa,d,∗ ()
- aDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- bDivision of Cardiology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora CO
- cThe Cooper Institute, Dallas, Texas
- dDepartment of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Address for correspondence:
Dr. Jarett D. Berry, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75309-9047.
Objectives This study evaluated the contributions of obesity and changes in body mass index (BMI) in mid-life to long-term heart failure (HF) risk independent of cardiorespiratory fitness (CRF) levels.
Background Obesity and low CRF are well-established risk factors for HF. However, given the inverse association between CRF and obesity, the independent contributions of BMI toward HF risk are not fully understood.
Methods We included 19,485 participants from the Cooper Center Longitudinal Study who survived to receive Medicare coverage, from 1999 to 2009. CRF was estimated in metabolic equivalents (METS) according to Balke treadmill time. Associations of BMI and BMI change with HF hospitalization after age 65 were assessed by applying a proportional hazards recurrent events model to the failure time data.
Results After 127,110 person-years of follow-up, we observed 1,038 HF hospitalization events. Higher mid-life BMI was significantly associated with greater risk of HF hospitalization after adjusting for established HF risk factors (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.12 to 1.26) per 3 kg/m2 higher BMI). This association was attenuated after adjusting for CRF (HR: 1.10; 95% CI: 1.03 to 1.17 per 3 kg/m2 higher BMI). CRF accounted for 47% of the HF risk associated with BMI. BMI change was not significantly associated with risk of HF in older age after adjustment for CRF change.
Conclusions Higher BMI-associated risk of HF is explained largely by differences in CRF levels. Furthermore, BMI change is not significantly associated with HF risk after adjusting for CRF changes. These findings highlight the importance of CRF in mediating BMI-associated HF risk.
Dr. Berry has received funding from the Dedman Family Scholar in Clinical Care endowment at University of Texas Southwestern Medical Center; and from the American Heart Association prevention network (grant 14SFRN20740000). Dr. Cornwell has received research support from National Heart, Lung, and Blood Institute K23 career development award (1K23HL132048-01). All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The corresponding author had full access to all data in the study and final responsibility for the decision to submit for publication. All authors have read and agree to the manuscript as written. Drs. Pandey and Cornwell contributed equally to this work.
- Received September 12, 2016.
- Revision received December 26, 2016.
- Accepted December 28, 2016.
- 2017 American College of Cardiology Foundation