Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study

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• 作者：Yashashwi Pokharel ; MD ; MSCR^a ; ^b ; ^c ; Wensheng Sun ; MPH^a ; Salim S. Virani ; MD ; PhD^a ; ^b ; ^d ; Vijay Nambi ; MD ; PhD^a ; ^b ; ^d ; Ron C. Hoogeveen ; PhD^a ; ^b ; Patricia P. Chang ; MD ; MHS^e ; Chiadi E. Ndumele ; MD ; MHS^f ; Scott D. Solomon ; MD^g ; Biykem Bozkurt ; MD ; PhD^a ; ^d ; Elizabeth Selvin ; PhD^f ; Christie M. Ballantyne ; MD^a ; ^b ; Anita Deswal ; MD ; MPH^a ; ^d ; ^{adeswal@bcm.edu}
• 关键词：heart failure ; myocardial injury ; obesity paradox ; outcomes
• 刊名：JACC: Heart Failure
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：5
• 期：1
• 页码：56-63
• 全文大小：706 K
• 卷排序：5

文摘

This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories.BackgroundObesity 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.MethodsStratifying 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.ResultsMean 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 <14 ng/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 <14 ng/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.ConclusionAlthough 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)