Metabolic dysfunction and incidence of heart failure subtypes among Black individuals: The Jackson Heart Study
Arnaud D Kaze1, Alain G Bertoni2, Ervin R Fox3
1Department of Medicine, Division of Cardiology, Banner-University Medical Center Phoenix, The University of Arizona College of Medicine, Phoenix, AZ, USA.
Insights
Metabolic syndrome severity significantly increases heart failure risk in Black individuals. Managing metabolic health is crucial for preventing both heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Metabolic Health
- Public Health
Background:
- Metabolic syndrome (MetS) is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.
- The impact of MetS severity on subclinical cardiac changes and heart failure (HF) incidence, particularly HF subtypes, remains understudied in diverse populations.
- Black individuals experience a disproportionately high burden of MetS and HF, necessitating population-specific research.
Purpose of the Study:
- To investigate the association between MetS severity and subclinical myocardial remodelling.
- To assess the relationship between MetS severity and the incidence of HF, including HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).
- To examine these associations specifically within a cohort of Black individuals.
Main Methods:
- The study analyzed data from 4069 participants in the Jackson Heart Study without pre-existing HF.
- MetS status and severity were assessed using scores based on waist circumference (MetS-Z-WC) and body mass index (MetS-Z-BMI).
- Associations with echocardiographic parameters, cardiac biomarkers (hs-cTnI, BNP), and incident HF hospitalizations (HFpEF, HFrEF) were evaluated over a median follow-up of 12 years.
Main Results:
- MetS severity correlated with subclinical cardiac remodelling and elevated cardiac biomarkers.
- Over 12 years, 319 participants developed HF. MetS was linked to a twofold increased risk of HF (HR 2.07).
- Higher MetS-Z-WC quartiles significantly elevated HF risk, with a markedly stronger association for HFpEF (Q4 vs. Q1 HR 4.94) compared to HFrEF (HR 1.69).
Conclusions:
- Metabolic syndrome severity is significantly associated with increased risk for both HFpEF and HFrEF in Black individuals.
- These findings underscore the critical role of optimizing metabolic health in preventing HF subtypes.
- Targeting MetS interventions may be key to reducing HF disparities in this population.
Aims:
The extent to which metabolic syndrome (MetS) severity influences subclinical myocardial remodelling, heart failure (HF) incidence and subtypes, remains unclear. We assessed the association of MetS with incident HF (including ejection fraction subtypes) among Black individuals.
Methods And Results:
We included 4069 Jackson Heart Study participants (mean age 54.4 years, 63.8% women, 37.2% with MetS) without HF. We categorized participants based on MetS status and MetS severity scores (based on waist circumference [MetS-Z-WC] and body mass index [MetS-Z-BMI]). We assessed the associations of MetS indices with echocardiographic parameters, biomarkers of myocardial damage (high-sensitivity cardiac troponin I [hs-cTnI] and B-type natriuretic peptide [BNP]) and incident HF hospitalizations including HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). MetS severity was associated with subclinical cardiac remodelling (assessed by echocardiographic measures and biomarkers of myocardial damage). Over a median of 12 years, 319 participants developed HF (157 HFpEF, 149 HFrEF and 13 HF of unknown type). MetS was associated with a twofold greater risk of HF (hazard ratio [HR] 2.07, 95% confidence interval [CI] 1.64-2.61). Compared to the lowest quartile (Q1) of MetS-Z-WC, the highest quartile (Q4) conferred a higher risk of HF (HR 2.35, 95% CI 1.67-3.30), with a stronger association for HFpEF (Q4 vs. Q1: HR 4.94, 95% CI 2.67-9.14) vs. HFrEF (HR 1.69, 95% CI 1.06-2.70).
Conclusions:
Metabolic syndrome severity was associated with both HF subtypes among Black individuals, highlighting the importance of optimal metabolic health for preventing HF.
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