The Relationship Between Measures of Obesity and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis
Obesity has been associated with heart failure (HF), but there are conflicting reports on the best measure of obesity for the prediction of incident HF. This prospective study involved 6,809 participants in the Multi-Ethnic Study of Atherosclerosis, who were aged 45-84 years and without clinical cardiovascular disease at baseline. Cox-Proportional hazards models were used to examine the associations of body mass index (BMI) and waist circumference (WC) with incident HF. The predictive abilities of BMI and WC for incident HF were determined using receiver operating characterstic curves. After adjusting for confounders, BMI and WC were associated with incident HF in men [1.33 (1.10-1.61) and 1.38 (1.18-1.62) respectively] and women [1.70 (1.33-2.17) and 1.64 (1.29-2.08) respectively]. These associations were not significant after adjusting for obesity-related conditions such as hypertension, hypercholesterolemia, dysglycemia, left ventricular hypertrophy, kidney disease and inflammation. The associations of BMI and WC with incident HF did not vary by ethnicity or age-group (p>0.05), but paradoxically were inverse in Hispanic men. The area under the curve for BMI and WC for HF prediction was 0.749 and 0.750, respectively, and 0.782 and 0.777, respectively, in women. The association between obesity and incident HF is largely mediated by obesity-related conditions. BMI and WC have similar predictive abilities for incident HF.
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