Related Experiment Videos
The Obesity and Heart Failure Epidemics Among African Americans: Insights From the Jackson Heart Study
Arun Krishnamoorthy1, Melissa A Greiner2, Alain G Bertoni3
1Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Insights
Obesity is common in African Americans and linked to higher heart failure risk. Morbid obesity increases heart failure hospitalizations, but obesity is not associated with mortality in this population.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- African Americans exhibit higher rates of obesity and heart failure.
- The association between obesity and mortality in this demographic is not well-established.
- This study investigates the clinical implications of obesity in African Americans.
Purpose of the Study:
- To examine the intermediate and long-term clinical implications of obesity in African Americans.
- To assess the association between obesity and all-cause mortality.
- To determine the relationship between obesity and heart failure (HF) and HF hospitalization.
Main Methods:
- Retrospective analysis of 5292 African Americans from the Jackson Heart Study (2000-2013).
- Cox proportional hazards models and modified Poisson models were used.
- Outcomes included all-cause mortality, heart failure development, and heart failure hospitalization based on Body Mass Index (BMI).
Main Results:
- Obesity (27%) and morbid obesity (27%) were prevalent in the sample.
- Increasing BMI correlated with decreased mortality (P=.007) but increased heart failure (P<.001).
- Each 1-point BMI increase raised heart failure risk by 5% (HR 1.05; P<.001); morbid obesity increased HF hospitalization risk.
Conclusions:
- Obesity and morbid obesity are common in the studied African American community.
- Both obesity and morbid obesity are associated with increased risk of heart failure.
- Obesity was linked to higher rates of heart failure hospitalization, but not mortality.
Background:
Higher rates of obesity and heart failure have been observed in African Americans, but associations with mortality are not well-described. We examined intermediate and long-term clinical implications of obesity in African Americans and associations between obesity and all-cause mortality, heart failure, and heart failure hospitalization.
Methods And Results:
We conducted a retrospective analysis of a community sample of 5292 African Americans participating in the Jackson Heart Study between September 2000 and January 2013. The main outcomes were associations between body mass index (BMI) and all-cause mortality at 9 years and heart failure hospitalization at 7 years using Cox proportional hazards models and interval development of heart failure (median 8 years' follow-up) using a modified Poisson model. At baseline, 1406 (27%) participants were obese and 1416 (27%) were morbidly obese. With increasing BMI, the cumulative incidence of mortality decreased (P= .007), whereas heart failure increased (P < .001). Heart failure hospitalization was more common among morbidly obese participants (9.0%; 95% confidence interval [CI] 7.6-11.7) than among normal-weight patients (6.3%; 95% CI 4.7-8.4). After risk adjustment, BMI was not associated with mortality. Each 1-point increase in BMI was associated with a 5% increase in the risk of heart failure (hazard ratio 1.05; 95% CI 1.03-1.06; P < .001) and the risk of heart failure hospitalization for BMI greater than 32 kg/m(2) (hazard ratio 1.05; 95% CI 1.03-1.07; P < .001).
Conclusions:
Obesity and morbid obesity were common in a community sample of African Americans, and both were associated with increased heart failure and heart failure hospitalization.