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Adiposity, fat-free mass and incident heart failure in 500 000 individuals
Ayodipupo S Oguntade1,2, Hannah Taylor3, Ben Lacey3,4
1Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK ayodipupooguntade@gmail.com.
Insights
Central adiposity and excess body fat significantly increase heart failure (HF) risk. Fat-free mass association with HF is mainly due to fat mass, and fat distribution impacts HF subtypes differently.
Area of Science:
- Cardiology
- Metabolic Health
- Epidemiology
Background:
- The distinct roles of body fat distribution and fat-free mass in heart failure (HF) risk require clarification.
- Understanding these body composition factors is crucial for predicting and preventing HF.
Purpose of the Study:
- To investigate the independent contributions of various body composition compartments to the risk of developing HF.
- To explore how body fat distribution influences different HF subtypes.
Main Methods:
- Analysis of 428,087 UK Biobank participants with a median follow-up of 13.8 years.
- Utilized adjusted Cox proportional hazards regression models to assess associations between body composition and incident HF.
- Examined measures including waist circumference (WC), body mass index (BMI), body fat, fat-free mass, visceral fat (VAT), and subcutaneous fat.
Main Results:
- HF risk was more strongly linked to central adiposity (WC adjusted for BMI) than general adiposity (BMI adjusted for WC).
- Visceral fat (VAT) showed an independent association with HF risk, even after adjusting for subcutaneous fat.
- HF with preserved ejection fraction was associated with all fat measures, whereas HF with reduced ejection fraction was not independently associated with fat measures.
Conclusions:
- Excess adiposity and fat mass are key contributors to increased HF risk.
- The association between fat-free mass and HF risk appears largely explained by its correlation with fat mass.
- Body fat distribution has independent relevance to HF subtypes, suggesting distinct underlying pathogenic mechanisms.
Background And Aims:
The independent role of body fat distribution and fat-free mass in heart failure (HF) risk is unclear. We investigated the role of different body composition compartments in risk of HF.
Methods:
Present analyses include 428 087 participants (mean age 55.9 years, 44% male) from the UK Biobank. Associations of long-term average levels of body composition measures with incident HF were determined using adjusted Cox proportional hazards regression models.
Results:
Over a median follow-up of 13.8 years, there were 10 455 first-ever incident HF events. Overall, HF risk was more strongly associated with central adiposity (waist circumference (WC) adjusted for body mass index (BMI); HR 1.38, 95% CI 1.32 to 1.45) than general adiposity (BMI adjusted for WC; HR 1.22, 95% CI 1.16 to 1.27). Although dual X-ray absorptiometry-derived body fat remained positively related to HF after adjustment for fat-free mass (HR 1.37, 95% CI 1.18 to 1.59), the association of fat-free mass with HF was substantially attenuated by fat mass (HR 1.12, 95% CI 1.01 to 1.26) while visceral fat (VAT) remained associated with HF independent of subcutaneous fat (HR 1.20, 95% CI 1.09 to 1.33). In analyses of HF subtypes, HF with preserved ejection fraction was independently associated with all fat measures (eg, VAT: HR 1.23, 95% CI 1.12 to 1.35; body fat: HR 1.36, 95% CI 1.17 to 1.57) while HF with reduced ejection fraction was not independently associated with fat measures (eg, VAT: HR 1.29, 95% CI 0.98 to 1.68; body fat: HR 1.29, 95% CI 0.80 to 2.07).
Conclusions:
This large-scale study shows that excess adiposity and fat mass are associated with higher HF risk while the association of fat-free mass with HF could be explained largely by its correlation with fat mass. The study also describes the independent relevance of body fat distribution to HF subtypes, suggesting different mechanisms may be driving their aetiopathogenesis.
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