Obesity, subclinical myocardial injury, and incident heart failure

JACC Heart Fail. 2014 Dec;2(6):600-7. doi: 10.1016/j.jchf.2014.05.017. Epub 2014 Oct 22.

Abstract

Objectives: The study sought to evaluate the association of obesity with a novel biomarker of subclinical myocardial injury, cardiac troponin T measured with a new high-sensitivity assay (hs-cTnT), among adults without clinical cardiovascular disease (CVD).

Background: Laboratory evidence suggests a relationship between obesity and myocardial injury that may play a role in the development of heart failure (HF), but there is limited clinical data regarding this association.

Methods: We evaluated 9,507 participants in the ARIC (Atherosclerosis Risk in Communities) study without baseline CVD (Visit 4, 1996 to 1999). We assessed the cross-sectional association of body mass index (BMI) with high (≥14 ng/l) and measurable (≥3 ng/l) hs-cTnT levels after multivariable regression. We further evaluated the independent and combined associations of BMI and hs-cTnT with incident HF.

Results: Higher BMI was independently associated with a positive, linear increase in the likelihood of high hs-cTnT, with severe obesity (BMI >35 kg/m(2)) associated with an odds ratio of 2.20 (95% confidence interval: 1.59 to 3.06) for high hs-cTnT after adjustment. Over 12 years of follow-up, there were 869 incident HF events. Obesity and hs-cTnT were both independently associated with incident HF, and individuals with severe obesity and high hs-cTnT had a greater than 9-fold higher risk of incident HF (hazard ratio: 9.20 [95% confidence interval: 5.67 to 14.93]) than individuals with normal weight and undetectable hs-cTnT.

Conclusions: Among individuals without CVD, higher BMI has an independent, linear association with subclinical myocardial injury, as assessed by hs-cTnT levels. Obesity and hs-cTnT provide independent and complementary prognostic information regarding the risk of incident HF.

Keywords: epidemiology; heart failure; obesity; troponin.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Biomarkers / metabolism
  • Body Mass Index
  • Cholesterol, LDL / metabolism
  • Coronary Artery Disease / etiology
  • Female
  • Heart Failure / etiology*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Natriuretic Peptide, Brain / metabolism
  • Obesity / complications*
  • Peptide Fragments / metabolism
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • Troponin T / metabolism
  • Waist Circumference / physiology

Substances

  • Biomarkers
  • Cholesterol, LDL
  • Peptide Fragments
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain