title: Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study.
abstract: This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories.
  
  
  
  Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity cardiac troponin T (hs-cTnT) is a sensitive marker of myocardial injury, and predicts incident HF and mortality.
  
  
  
  Stratifying 1,279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (< and ≥ 14 ng/l), we examined the association of pre-HF body mass index (BMI) with mortality after incident HF hospitalization in the ARIC (Atherosclerosis Risk In Communities) study.
  
  
  
  Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT ≥14 ng/l had higher mortality after incident HF (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.18 to 1.80) compared to individuals with hs-cTnT <14 ng/l in an adjusted model including BMI. Compared with normal weight subjects, the mortality was lower in overweight (HR: 0.69, 95% CI 0.48-0.98) and obese individuals (HR: 0.50; 95% CI: 0.35 to 0.72) with hs-cTnT <14 ng/l; and in those with hs-cTnT ≥14 ng/l (overweight HR: 0.50; 95% CI: 0.30 to 0.83; obese HR: 0.56; 95% CI: 0.34 to 0.91; interaction: p = 0.154 between BMI and hs-cTnT). The lower mortality risk in obese and overweight subjects remained similar when log hs-cTnT was added as a continuous variable to a multivariable model, and in sensitivity analyses after further adjusting for left ventricular hypertrophy or high-sensitivity C-reactive protein.
  
  
  
  Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury. (Atherosclerosis Risk In Communities [ARIC]; NCT00005131).
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Sun
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Chiadi E
authors.initials: CE
authors.lastname: Ndumele
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: adeswal@bcm.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications*; D012680:Sensitivity and Specificity; D015996:Survival Rate; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: heart failure; myocardial injury; obesity paradox; outcomes