Abstract P319: Racial Differences and Temporal Trends in Obesity Among Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction: The ARIC Study Community Surveillance
Caughey, MC; Vaduganathan, M; Arora, S; Qamar, A; Mentz, RJ; Chang, P; Russell, SD; Shah, SJ; Rosamond, WD; Pandey, A
Published in: Circulation
Obesity is disproportionately prevalent in black populations and strongly associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox” or lower mortality risk with obesity, has been reported in HFpEF populations. Whether racial differences exist in the temporal trends and outcomes of obesity is uncertain.
Hospitalizations for acute decompensated heart failure (ADHF) were sampled from 2005-2014 by the ARIC Study Community Surveillance and classified by physician review. BMI was calculated using the admission height and weight. Associations between obesity and 1-year all-cause mortality were analyzed with multivariable Cox regression.
There were 10,147 weighted hospitalizations for ADHF with ejection fraction ≥50% (64% female, 74% white). Overall, black patients had a higher mean BMI than white patients (34 vs. 30 kg/m
;
<0.0001), and a greater prevalence of obesity (56% vs. 43%;
<0.0001). Mean BMI and obesity steadily increased from 2005-2014 for white patients (Trends:
= 0.003 and
= 0.002) while remaining stable for black patients. Within BMI groups (18.5-24, 25-30, 30-35, 35-40, and ≥40 kg/m
) a U-shaped mortality risk was observed, with the lowest risk among patients with a BMI of 30-35 kg/m
(
). When defining obesity by a BMI cutpoint ≥30 kg/m
, the “obesity paradox” was apparent in 2005-2009 for white obese vs. non-obese patients (HR = 0.58, 95% CI: 0.38 - 0.80), but attenuated by 2010-2014 (HR = 1.11; 95% CI: 0.80 - 1.48);
for interaction =0.006. Among black patients, there was no survival benefit for a BMI ≥30 kg/m
in 2005-2009 (HR = 1.15; 95% CI; 0.65 - 2.02) or 2010-2014 (HR = 1.06; 95% CI: 0.68 - 1.66).
In this decade-long community surveillance of HFpEF patients hospitalized with ADHF, obesity and mean BMI were stable for black patients but steadily increased for white patients. A BMI ≥30 kg/m
was initially associated with better survival among white patients but the association dissipated as obesity and mean BMI increased over time.
