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Published on: March 29, 2024
Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based
Bart J Van Essen1, Nathalie Ang En Dan2, Ganash N Tharsana2
1University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
Insights
Certain combinations of chronic conditions significantly increase heart failure (HF) risk. The elderly, pulmonary disease, and obese/physically inactive clusters showed the highest risk for developing HF.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Comorbidities are linked to increased heart failure (HF) risk.
- Multimorbidity clusters and their specific associations with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) remain understudied.
Purpose of the Study:
- To identify distinct multimorbidity clusters within a large cohort.
- To investigate the differential association of these clusters with incident HFpEF and HFrEF.
Main Methods:
- Latent class analysis was used to identify multimorbidity patterns in 6839 participants from the PREVEND cohort.
- Prospective observational design with 110,621 person-years of follow-up.
- Cox proportional hazards models were used to assess associations with incident HF, adjusting for confounders.
Main Results:
- Six multimorbidity clusters were identified: young, elderly, pulmonary disease, psychosomatic, psychological, and obese/physical inactivity.
- The elderly, pulmonary disease, and obese/physical inactivity clusters were associated with a significantly higher risk of incident HF compared to the young cluster.
- While HFrEF was more common overall, the obese/physical inactivity cluster showed a relatively higher likelihood of developing HFpEF.
Conclusions:
- Comorbidities form distinct clusters that differentially impact HF risk.
- Recognizing and addressing these multimorbidity patterns is crucial for HF prevention and management.
Background:
Comorbidities are associated with an increased risk of incident heart failure (HF). However, comorbidities usually cluster together and data on the association between multimorbidity clusters and incident HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) are lacking.
Methods:
We identified multimorbidity patterns in 6839 participants from the prospective observational Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort study using latent class analysis and investigated their association with new-onset HF.
Results:
The participants' mean age at baseline was 53.8 years, and 50 % were women. We identified six multimorbidity clusters: 1) young [N = 2118, youngest age and lowest number of chronic conditions], 2) elderly [N = 1198, oldest age, high prevalence of chronic kidney disease and hypercholesterolemia], 3) pulmonary disease [N = 578, high prevalence of respiratory problems], 4) psychosomatic [N = 527, high prevalence of myalgic encephalomyelitis, anxiety and stress], 5) psychological [N = 1815, high prevalence of depression] and 6) obese/physical inactivity [N = 603, high prevalence of obesity, hypertension, myocardial infarction and stroke]. During 110,621 person-years of follow-up 622 participants developed heart failure of which 390 with HFrEF and 220 with HFpEF. After adjusting for potential confounders, the elderly (adjusted hazard ratio (aHR) 2.46, 95 % confidence interval (CI) 1.89-3.20), pulmonary disease (aHR 2.10, 95 % CI 1.51-2.92), and obese/physical inactivity (aHR 3.80, 95 % CI 2.86-5.06) clusters had a higher risk of HF compared with the young cluster, which had the lowest risk. Among all clusters, patients were more likely to develop HFrEF compared to HFpEF. However, the obese/physical inactivity cluster was relatively more likely to develop HFpEF than HFrEF.
Conclusions:
Comorbidities naturally clustered in six distinct multimorbidity clusters, each impacting participants' HF risk differently. These data emphasize the importance of addressing multimorbidity as a risk factor for HF.
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