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).
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Authors | Yashashwi Pokharel, Wensheng Sun, Salim S Virani, Vijay Nambi, Ron C Hoogeveen, Patricia P Chang, Chiadi E Ndumele, Scott D Solomon, Biykem Bozkurt, Elizabeth Selvin, Christie M Ballantyne, Anita Deswal |
Journal | JACC. Heart failure
(JACC Heart Fail)
Vol. 5
Issue 1
Pg. 56-63
(01 2017)
ISSN: 2213-1787 [Electronic] United States |
PMID | 28017350
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Published by Elsevier Inc. |
Chemical References |
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Topics |
- Aged
- Biomarkers
(blood)
- Cardiomyopathies
(blood, complications, mortality)
- Cohort Studies
- Female
- Heart Failure
(blood, etiology, mortality)
- Hospitalization
- Humans
- Male
- Middle Aged
- Obesity
(blood, complications)
- Sensitivity and Specificity
- Survival Rate
- Troponin T
(blood)
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