Early-Onset Obesity and Heart Failure Burden Independent of Cardiometabolic Risk Factors

The timing of obesity onset may influence long-term cardiovascular risk. Whether obesity beginning in early adulthood differs from obesity acquired later in life with respect to cardiometabolic and cardiovascular outcomes remains uncertain. We analysed adults with obesity (BMI ≥ 30 kg/m²) from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Participants were classified as having early-onset obesity (with obesity at approximately age 25) or adult-onset obesity (with obesity at study enrolment but not at age 25). Primary outcomes included measured hypertension and a composite of cardiovascular disease (CVD) (congestive heart failure [CHF], coronary heart disease, angina, myocardial infarction or stroke). The weighted population represented 19.4 million U.S. adults with obesity, including 2.56 million with early-onset obesity. Adjusted cardiometabolic measures did not differ. CHF was more common with early-onset obesity (13.5% vs. 6.6%), and adult-onset obesity was associated with lower odds of CHF (adjusted OR: 0.43, 95% CI: 0.23-0.82). No differences were observed for coronary heart disease, angina, myocardial infarction, stroke or hard CVD. Among U.S. adults with obesity, early-onset obesity is associated with a higher burden of CHF, suggesting a potential role of cumulative obesity exposure in heart failure development.