Abdominal obesity is an independent risk factor for chronic heart failure in older people.
OBJECTIVE
To examine whether total and abdominal adiposity are risk factors for the development of chronic heart failure (CHF) in older men and women.


METHODS
Prospective, longitudinal cohort: The Health, Aging and Body Composition study.


METHODS
Memphis, Tennessee, and Pittsburgh, Pennsylvania, metropolitan areas.


METHODS
Three thousand seventy-five well-functioning community-dwelling older adults aged 70 to 79.


METHODS
Body composition using dual energy X-ray absorptiometry, visceral adipose tissue area using computed tomography, adjudicated CHF.


RESULTS
Of the remaining (640 participants excluded from original group of 3,075) 2,435 participants (1,081 men, 1,354 women) without coronary heart disease or CHF at baseline, there were 166 confirmed diagnoses of CHF during the median+/-standard deviation (SD) follow-up of 6.1+/-1.4 years. After adjustment for age, race, sex, site, education, smoking, and chronic obstructive pulmonary disorder, all adiposity variables (body mass index (BMI), adipose tissue mass, percentage body fat, waist-to-thigh ratio, waist circumference, and visceral and subcutaneous abdominal adipose tissue) were significant predictors of the development of CHF. In a model that included waist circumference and BMI, waist circumference was associated with incident CHF (hazard ratio (HR)=1.27, 95% confidence interval (CI)=1.04-1.54 per SD increase, P=.02), but BMI was not (HR=1.08, 95% CI=0.86-1.35). When waist circumference and percentage fat were included together, both variables were significant predictors of CHF (waist: HR=1.17, 95% CI=1.00-1.36 per SD increase, P=.05; percentage fat: HR=1.47, 95% CI=1.16-1.87 per SD increase, P=.002). Stepwise adjustment for inflammation, hypertension, insulin resistance, and diabetes mellitus did not decrease the relative risk of a greater waist circumference for the development of CHF (all HR=1.27-1.32, 95% CI=1.02-1.61 per SD increase).


CONCLUSIONS
Abdominal body fat distribution may be a stronger risk factor for CHF than overall obesity.
Nicklas
Barbara J
BJ
Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. bnicklas@wfubmc.edu
Cesari
Matteo
M
Penninx
Brenda W J H
BW
Kritchevsky
Stephen B
SB
Ding
Jingzhong
J
Newman
Anne
A
Kitzman
Dalane W
DW
Kanaya
Alka M
AM
Pahor
Marco
M
Harris
Tamara B
TB
D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D050218:Body Fat Distribution; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed