Inspecting the association between metabolic obese phenotypes and heart failure subtypes risk

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.

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).

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.

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.

MUNO and MUO were associated with all HF subtypes risk, while MHO was only associated with future HFpEF rather than HFrEF/HFmrEF.