Dataset Information

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

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 <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. 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).

SUBMITTER: Pokharel Y

PROVIDER: S-EPMC5425302 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Pokharel Yashashwi Y Sun Wensheng W Virani Salim S SS Nambi Vijay V Hoogeveen Ron C RC Chang Patricia P PP Ndumele Chiadi E CE Solomon Scott D SD Bozkurt Biykem B Selvin Elizabeth E Ballantyne Christie M CM Deswal Anita A

JACC. Heart failure 20161221 1

<h4>Objectives</h4>This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories.<h4>Background</h4>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.<h4>Methods</h4>Stratifying 1,279 individuals with incident HF hospitalizatio ...[more]

PMID: 28017350

Similar Datasets

Project description:BackgroundAlthough silent myocardial infarction (SMI) accounts for about one-half of the total number of myocardial infarctions (MIs), the risk of heart failure (HF) among patients with SMI is not well established.ObjectivesThe purpose of this study was to examine the association of SMI and clinically manifested myocardial infarction (CMI) with HF, as compared with patients with no MI.MethodsThis analysis included 9,243 participants from the ARIC (Atherosclerosis Risk In Communities) study who were free of cardiovascular disease at baseline (ARIC visit 1: 1987 to 1989). SMI was defined as electrocardiographic evidence of MI without CMI after the baseline until ARIC visit 4 (1996 to 1998). HF events were ascertained starting from ARIC visit 4 until 2010 in individuals free of HF before that visit.ResultsBetween ARIC visits 1 and 4, 305 SMIs and 331 CMIs occurred. After ARIC visit 4 and during a median follow-up of 13.0 years, 976 HF events occurred. The incidence rate of HF was higher in both CMI and SMI participants than in those without MI (incidence rates per 1,000 person-years were 30.4, 16.2, and 7.8, respectively; p < 0.001). In a model adjusted for demographics and HF risk factors, both SMI (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.02 to 1.78) and CMI (HR: 2.85; 95% CI: 2.31 to 3.51) were associated with increased risk of HF compared with no MI. These associations were consistent in subgroups of participants stratified by several HF risk predictors. However, the risk of HF associated with SMI was stronger in those younger than the median age (53 years) (HR: 1.66; 95% CI: 1.00 to 2.75 vs. HR: 1.19; 95% CI: 0.85 to 1.66, respectively; overall interaction p by MI type <0.001).ConclusionsSMI is associated with an increased risk of HF. Future research is needed to examine the cost effectiveness of screening for SMI as part of HF risk assessment, and to identify preventive therapies to improve the risk of HF among patients with SMI.

Dataset Information

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

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets