Abdominal Obesity Is an Independent Risk Factor for Chronic Heart Failure in Older People

• Published in: Journal of the American Geriatrics Society (JAGS) 2006-03, Vol.54 (3), p.413-420
• Main Authors: Nicklas, Barbara J., Cesari, Matteo, Penninx, Brenda W.J.H., Kritchevsky, Stephen B., Ding, Jingzhong, Newman, Anne, Kitzman, Dalane W., Kanaya, Alka M., Pahor, Marco, Harris, Tamara B.
• Format: Article
• Language: English
• Subjects: Abdomen; Absorptiometry, Photon; Age Factors; Aged; Biological and medical sciences; Body fat; Body Fat Distribution; Body Mass Index; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; chronic heart failure; elderly; Female; Follow-Up Studies; General aspects; Geriatrics; Heart; Heart failure; Heart Failure - epidemiology; Heart Failure - etiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Incidence; Male; Medical sciences; Metabolic diseases; Obesity; Obesity - complications; Obesity - diagnosis; Obesity - epidemiology; Older people; Prospective Studies; Risk Factors; Severity of Illness Index; Tomography, X-Ray Computed; waist circumference
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2005.00624.x

OBJECTIVES: To examine whether total and abdominal adiposity are risk factors for the development of chronic heart failure (CHF) in older men and women. DESIGN: Prospective, longitudinal cohort: The Health, Aging and Body Composition study. SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania, metropolitan areas. PARTICIPANTS: Three thousand seventy‐five well‐functioning community‐dwelling older adults aged 70 to 79. MEASUREMENTS: Body composition using dual energy X‐ray absorptiometry, visceral adipose tissue area using computed tomography, adjudicated CHF. RESULTS: Of the remaining (640 participants excluded from original group of 3,075) 2,435 participants (1,081 men, 1,354 women) without coronary heart disease or CHF at baseline, there were 166 confirmed diagnoses of CHF during the median±standard deviation (SD) follow‐up of 6.1±1.4 years. After adjustment for age, race, sex, site, education, smoking, and chronic obstructive pulmonary disorder, all adiposity variables (body mass index (BMI), adipose tissue mass, percentage body fat, waist‐to‐thigh ratio, waist circumference, and visceral and subcutaneous abdominal adipose tissue) were significant predictors of the development of CHF. In a model that included waist circumference and BMI, waist circumference was associated with incident CHF (hazard ratio (HR)=1.27, 95% confidence interval (CI)=1.04–1.54 per SD increase, P=.02), but BMI was not (HR=1.08, 95% CI=0.86–1.35). When waist circumference and percentage fat were included together, both variables were significant predictors of CHF (waist: HR=1.17, 95% CI=1.00–1.36 per SD increase, P=.05; percentage fat: HR=1.47, 95% CI=1.16–1.87 per SD increase, P=.002). Stepwise adjustment for inflammation, hypertension, insulin resistance, and diabetes mellitus did not decrease the relative risk of a greater waist circumference for the development of CHF (all HR=1.27–1.32, 95% CI=1.02–1.61 per SD increase). CONCLUSION: Abdominal body fat distribution may be a stronger risk factor for CHF than overall obesity.