Author + information
- Received July 3, 2018
- Accepted July 24, 2018
- Published online October 10, 2018.
- Vishal N. Rao, MD, MPHa,b,
- Di Zhao, PhDc,
- Matthew A. Allison, MD, MPHd,
- Eliseo Guallar, MD, DrPHc,
- Kavita Sharma, MDa,
- Michael H. Criqui, MD, MPHd,
- Mary Cushman, MDe,
- Roger S. Blumenthal, MDa and
- Erin D. Michos, MD, MHSa,c,∗ ()
- aCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
- bDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina
- cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- dDivision of Preventive Medicine, University of California San Diego, La Jolla, California
- eDivision of Hematology, University of Vermont, Burlington, Vermont
- ↵∗Address for correspondence:
Dr. Michos, Division of Cardiology, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287.
Objectives The aim of this paper is to compare various measures of adiposity with risk for incident hospitalized heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).
Background Obesity is a risk factor for HF, particularly HFpEF. It is unknown which measures of adiposity, including anthropometrics and computed tomography (CT)-measured fat area, are most predictive of HF subtypes.
Methods We studied 1,806 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) study without baseline cardiovascular disease who underwent anthropometrics (body mass index [BMI] and waist circumference) and an abdominal CT. Subcutaneous and visceral adipose tissue (VAT) were measured from a single CT slice at L2-L3. Cox hazard models were used to examine associations of adiposity with incident hospitalized HFpEF and HFrEF events. Fully adjusted models included demographics, HF risk factors, and N-terminal pro-B-type natriuretic peptide.
Results Over a mean follow-up of 11 years, there were 34 HFpEF and 36 HFrEF events. The fully adjusted hazard ratio (95% confidence interval [CI]) per 1-SD higher of each anthropometric and CT-measured adiposity measures for incident HFpEF were as follows: BMI HR: 1.66; 95% CI: 1.12 to 2.45; waist circumference HR: 1.59; 95% CI: 1.05 to 2.40; and VAT HR: 2.24; 95% CI: 1.44 to 3.49. None of these adiposity measures were associated with HFrEF. Even among overweight/obese adults (BMI ≥25 kg/m2), assessment of VAT (per 1-SD) was strongly associated with HFpEF (HR: 2.78; 95% CI: 1.62 to 4.76). Subcutaneous adipose tissue was neither associated with HFpEF nor HFrEF.
Conclusions In a multiethnic cohort free of cardiovascular disease, CT-measured VAT was independently associated with incident hospitalized HFpEF but not HFrEF. Measuring visceral fat at the time of CT imaging for other indications may offer additional prognostication of HF risk. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)
Drs. Michos and Zhao are supported by the Blumenthal Scholars Fund at Johns Hopkins for Preventive Cardiology Research. This research was also supported by NIH grant R01 HL088451. The MESA study is supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the NIH/NHLBI; by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from NCATS. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 3, 2018.
- Accepted July 24, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.