Obesity Linked to Elevated Risk of Heart Failure in Persons with Diabetes

Increases in obesity parameters significantly increased risk of incident heart failure in persons with diabetes, but not without diabetes, in a large community-based cohort study.

Among older adults with diabetes, higher body mass index (BMI), waist circumference, and fat mass are each significantly associated with greater risk of heart failure (HF), but the relationship does not hold for those without diabetes, according to findings published in the journal Circulation.

While the association of diabetes and obesity with increased risk of HF is well recognized, senior author Ambarish Pandey, MD, assistant professor in the department of internal medicine at the University of Texas Southwestern Medical Center, Dallas, and colleagues point to poor understanding of the relationship between different measures of adiposity and diabetes status for HF.

To investigate further, Pandey et al obtained participant-level data from the Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) community-based cohorts, harmonizing and pooling the information and excluding records of those with prevalent HF.
The final study data set included 10 387 participants (ARIC n= 5494; CHS, n=4892) with a median age of 74 years.

One-quarter (25.1%) of the study cohort had diabetes, 36.0% had prediabetes, 25.8% had overall obesity (BMI ≥30 kg/m2), and 55.9% had abdominal obesity (waist circumference >88 cm in women and >102 cm in men).

The researchers report that during a follow-up period of 5 years, 4.3% of participants developed HF. They found that higher levels of each measure of adiposity were significantly associated with higher HF risk. Specifically, multivariable analysis showed a significantly increased risk for HF overall for each standard deviation increase in BMI (hazard ratio [HR], 1.19), waist circumference (HR, 1.27) and estimated fat mass (HR, 1.17)

However, Pandey et al report that when the impact of the 3 adiposity parameters on HF was stratified by diabetes status, higher measures of each were significantly associated with higher risk of incident HF among patients with baseline diabetes than among those without, the latter group including participants with prediabetes as well as those with euglycemia.

For each standard deviation increase in parameter, risk for HF in participants with diabetes increased:

* 1.29-fold for BMI
* 1.48-fold for waist circumference
* 1.25-fold for fat mass

Further analysis revealed that among participants with diabetes, the population attributable risk percentage for incident HF was 12.8% for BMI, 29.9% for waist circumference, and 13.7% for fat mass. In contrast, the corresponding values among the population without diabetes were ≤1%, at 1.0%, 0.9%, and 0.5%, respectively.

Writing in the study’s discussion, the authors note that their study demonstrated that diabetes modifies the risk of HF as measures of obesity increase while the risk of HF among those with obesity and without diabetes “was comparable to healthier weight individuals.”

“Future efforts should be directed at aggressive implementation of [sodium-glucose cotransporter 2 inhibitors] in individuals with diabetes and obesity at the highest risk of developing HF,” they added.

Reference: Patel KV, Segar MW, Lavie CJ, et al. Diabetes status modifies the association between different measures of obesity and heart failure risk among older adults: a pooled analysis of community-based NHLBI cohorts. Circulation. Published online December 3, 2021.