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Inspecting the association between metabolic obese phenotypes and heart failure subtypes risk
Jiancheng Zhang1,2, Bin Dong1,2, Jiayong Li1,2
1Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China.
Insights
Metabolically unhealthy obesity (MUO) and metabolically unhealthy non-obesity (MUNO) increase heart failure risk. Metabolically healthy obesity (MHO) is linked to heart failure with preserved ejection fraction (HFpEF), but not reduced ejection fraction (HFrEF/HFmrEF).
Area of Science:
- Cardiology
- Metabolic Health
- Epidemiology
Background:
- Obesity and metabolic dysfunction are distinct, yet their combined impact on heart failure (HF) subtypes remains unclear.
- Understanding these relationships is crucial for targeted prevention and treatment strategies.
Purpose of the Study:
- To investigate the association between distinct metabolic obese phenotypes and the future risk of developing specific heart failure subtypes.
- To analyze how transitions between phenotypes over time influence heart failure risk.
Main Methods:
- Utilized data from 9791 participants in the ARIC study.
- Classified participants into four phenotypes: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO).
- Employed Cox regression models to assess the risk of HF with preserved ejection fraction (HFpEF) and HF with reduced or mid-range ejection fraction (HFrEF/HFmrEF).
Main Results:
- Compared to MHNO, MHO, MUNO, and MUO phenotypes were associated with increased HFpEF risk.
- MUNO and MUO phenotypes showed increased risk for HFrEF/HFmrEF.
- Associations were more pronounced in individuals younger than 55 and females. Persistent unhealthy phenotypes (MHO, MUNO, MUO) elevated HFpEF risk, and transitions to MUO increased risk for all HF subtypes.
Conclusions:
- Metabolically unhealthy non-obesity (MUNO) and metabolically unhealthy obesity (MUO) are linked to increased risk across all heart failure subtypes.
- Metabolically healthy obesity (MHO) is specifically associated with an increased risk of HFpEF, but not HFrEF/HFmrEF.
Aim:
Obesity and metabolic unhealth don't always co-exist. The relation between phenotypes derived from metabolic obese status and heart failure (HF) subtypes categorized by left ventricular ejection fraction (LVEF) is unclear. We aimed to investigate the association between metabolic obese phenotypes and future HF subtypes risk.
Objectives:
A total of 9791 participants from the ARIC study were classified into phenotypes based on obese and metabolic status: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO) and metabolically unhealthy obesity (MUO).
Methods:
Cox regression models were applied to explore the relationship between metabolic obese phenotypes and risk of HF with preserved ejection fraction (HFpEF, LVEF ≥ 50 %) and HF with reduced or mid-range ejection fraction (HFrEF/HFmrEF, LVEF < 50 %) in total population and subgroups. Associations between phenotypes transition over time and HF subtypes risk were further analyzed.
Results:
Compared with MHNO participants, HFpEF risk was increased in MHO (hazard ratio and 95 % confidence interval, 1.77 [1.39-2.26]), MUNO (1.59 [1.27-1.99]) and MUO (2.77 [2.25-3.40]), while HFrEF/HFmrEF risk were higher in MUNO (1.61 [1.27-2.04]) and MUO (2.19 [1.74-2.75]) participants. Subgroup analyses revealed that the associations between metabolic obese phenotypes and HF subtypes risk were more predominant in participants < 55 years old and female. Persistent MHO, MUNO or MUO were associated with increased HFpEF risk and almost any transition to MUO resulted in increased risk of all HF subtypes.
Conclusions:
MUNO and MUO were associated with all HF subtypes risk, while MHO was only associated with future HFpEF rather than HFrEF/HFmrEF.
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