Abstract 12638: The Independent and Joint Associations of Obesity and Hypertension on Incident Heart Failure: A Pooled Cohort Analysis

Obesity and hypertension (HTN) are major risk factors for incident heart failure (HF). Obesity is a major cause of HTN; thus, it is difficult to disentangle the impact of each risk factor on HF incidence. Further, it is not established what factors modify these relationships. To assess the associations of obesity and HTN as well as their potential synergistic effect on incident HF in large, diverse populations. We studied participants of 3 major epidemiologic cohorts: Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Participants were stratified into 4 groups: neither obesity nor HTN (reference), only obesity, only HTN, or both obesity and HTN. HTN was defined as ≥140 mmHg systolic or ≥90 mmHg diastolic blood pressure or use of antihypertensive medications. Obesity was defined as body mass index ≥30 Kg/m2. Cox proportional hazards models adjusted for age, sex, race, smoking, alcohol use, diabetes, coronary heart disease, and estimated glomerular filtration rate were used to assess the association of 4 groups with incident HF. 18,351 participants (55.1% women and 31.4% black adults) followed over a mean 14 years were included in our analysis. Participants with only obesity (adjusted HR= 1.60; 95% CI 1.36 to 1.88) and only HTN (aHR 2.1; 95% CI 1.87, 2.37) demonstrated an increased risk of incident HF compared with participants with neither obesity nor HTN after adjustment for covariates. The greatest risk of incident HF was in participants with both obesity and HTN (aHR 2.97; 95% CI 2.63 to 3.36; Figure). HTN did not modify the effects of obesity or vice versa (p=0.193). Obesity and HTN are associated with incident HF and individuals with both have the highest risk of HF. This is an additive effect. These data emphasize the importance of blood pressure control and weight management in the prevention of HF.

Duke Scholars

Author Robert John Mentz Medicine, Cardiology