Myocardial injury, obesity, and the obesity paradox: The ARIC Study

Authors

Yashashwi Pokharel, Baylor College of Medicine, United States
Wensheng Sun Wensheng Sun, Baylor College of Medicine, United States
Salim S. Virani, Baylor College of Medicine, United StatesFollow
Vijay Nambi, Baylor College of Medicine, United States
Ron C. Hoogeveen, Baylor College of Medicine, United States
Patricia P. Chang, University of North Carolina, United States
Chiadi E. Ndumele, Johns Hopkins University, United States
Scott D. Solomon, Harvard Medical School, United States
Biykem Bozkurt, Baylor College of Medicine, United States
Elizabeth Selvin, Johns Hopkins University, United States

Document Type

Article

Department

Cardiology

Abstract

Objectives: This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories.
Background: Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity cardiac troponin T (hs-cTnT) is a sensitive marker of myocardial injury, and predicts incident HF and mortality.
Methods: Stratifying 1,279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (< and ≥ 14 ng/l), we examined the association of pre-HF body mass index (BMI) with mortality after incident HF hospitalization in the ARIC (Atherosclerosis Risk In Communities) study.
Results: Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT ≥14 ng/l had higher mortality after incident HF (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.18 to 1.80) compared to individuals with hs-cTnT/l in an adjusted model including BMI. Compared with normal weight subjects, the mortality was lower in overweight (HR: 0.69, 95% CI 0.48-0.98) and obese individuals (HR: 0.50; 95% CI: 0.35 to 0.72) with hs-cTnT/l; and in those with hs-cTnT ≥14 ng/l (overweight HR: 0.50; 95% CI: 0.30 to 0.83; obese HR: 0.56; 95% CI: 0.34 to 0.91; interaction: p = 0.154 between BMI and hs-cTnT). The lower mortality risk in obese and overweight subjects remained similar when log hs-cTnT was added as a continuous variable to a multivariable model, and in sensitivity analyses after further adjusting for left ventricular hypertrophy or high-sensitivity C-reactive protein.
Conclusion: Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury. (Atherosclerosis Risk In Communities [ARIC]; NCT00005131).

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

JACC: Heart Failure

Recommended Citation

Pokharel, Y., Wensheng Sun, W., Virani, S. S., Nambi, V., Hoogeveen, R. C., Chang, P. P., Ndumele, C. E., Solomon, S. D., Bozkurt, B., Selvin, E. (2017). Myocardial injury, obesity, and the obesity paradox: The ARIC Study. JACC: Heart Failure, 5(1), 56-63.
Available at: https://ecommons.aku.edu/provost_office/74