title: Obesity is an independent risk factor for heart failure: Zona Franca Cohort study.
abstract: BACKGROUND
  Heart failure (HF) is a major problem in developed countries. However, its relationship with obesity remains unclear, especially in low-risk populations. The objective of the study was to analyze the relationship between obesity and HF in a low-risk Mediterranean population.
  
  
  OBJECTIVE
  Obesity is an independent predictor for HF.
  
  
  METHODS
  A prospective community-based population cohort study with 10 years' follow-up was conducted at 2 healthcare centers in the city of Barcelona, Spain. From a registered population of 35 275, the study included 932 randomly selected patients without HF, age 35-84 years. Obesity was defined as body mass index (BMI) ≥30 and HF according to European Society of Cardiology guidelines, confirmed by echocardiography. Cox proportional hazards regression was used to examine the association between obesity and heart failure.
  
  
  RESULTS
  The difference in HF incidence between obese subjects (4.7%) and nonobese subjects (1.6%) was 3.1% (95% confidence interval [CI]: 0.7-5.5). In the unadjusted model, incident HF was significantly associated with BMI: the hazard ratio [HR] was 1.09 for every 1 kg/m² increase (95% CI: 1.05-1.14) and 3.01 for BMI ≥30 (95% CI: 1.34-6.77). After adjusting for age, sex, hypertension, ischemic heart disease, and diabetes mellitus, the results were similar: HR 1.06 (95% CI: 1.01-1.10) and HR 2.45 for BMI ≥30 (95% CI: 1.02-5.61). Overweight was not associated with HF in any of the models. The population-attributable risk of HF due to obesity was 43.0% (95% CI: 13.9-74.9).
  
  
  CONCLUSIONS
  High rate differences, HRs, and attributable risk indicate that obesity is an important risk factor for incident HF.
authors.affiliation: Primary Health Care Center La Marina, Primary Care Research Institute Jordi Gol, Barcelona, Spain. jbaena@imim.es
authors.forename: José M
authors.initials: JM
authors.lastname: Baena-Díez
authors.forename: Alice O
authors.initials: AO
authors.lastname: Byram
authors.forename: María
authors.initials: M
authors.lastname: Grau
authors.forename: Claudia
authors.initials: C
authors.lastname: Gómez-Fernández
authors.forename: Marc
authors.initials: M
authors.lastname: Vidal-Solsona
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ledesma-Ulloa
authors.forename: Isabel
authors.initials: I
authors.lastname: González-Casafont
authors.forename: Javier
authors.initials: J
authors.lastname: Vasquez-Lazo
authors.forename: Isaac
authors.initials: I
authors.lastname: Subirana
authors.forename: Helmut
authors.initials: H
authors.lastname: Schroder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors