Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
JACC Heart Fail. 2018 Aug;6(8):701-709. doi: 10.1016/j.jchf.2018.05.018. Epub 2018 Jul 11.
This study evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately.
Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear.
We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models.
The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI; 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18; 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34).
Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.
本研究评估了肥胖和心脏代谢特征与射血分数保留型心力衰竭（HFpEF 与射血分数降低型心力衰竭，HFrEF）之间的相关性。鉴于心力衰竭亚型存在已知的性别差异，我们分别对男性和女性进行了研究。
最近的研究表明，肥胖会增加 HFpEF 相较于 HFrEF 的风险。与 HFpEF 相关的代谢特征的贡献尚不明确。
我们研究了来自 4 个社区队列的 22681 名参与者，这些参与者发生了射血分数≥50%（HFpEF）与<50%（HFrEF）的心力衰竭事件。我们使用 Cox 模型评估了体重指数（BMI）和心脏代谢特征与心力衰竭亚型的相关性。
平均年龄为 60±13 岁，53%为女性。在中位随访 12 年后，有 628 人发生了 HFpEF 事件，835 人发生了 HFrEF 事件。与 HFrEF 相比，BMI 每增加 1 个标准差预示着更高的 HFpEF 风险（风险比[HR]：1.34；95%置信区间[CI]：1.24 至 1.45 与 HR：1.18；95% CI：1.10 至 1.27）。同样，胰岛素抵抗（稳态模型评估的胰岛素抵抗）与 HFpEF 相关（HR：1.20/标准差；95% CI：1.05 至 1.37），但与 HFrEF 无关（HR：0.99；95% CI：0.88 至 1.11；HFpEF 与 HFrEF 之间的差异 HR：0.05）。我们发现，与男性相比，BMI 与 HFpEF 之间的相关性在女性中更为显著（HFpEF 与 HFrEF 之间的差异 p=0.01）。
肥胖和相关的心脏代谢特征，包括胰岛素抵抗，与未来 HFpEF 与 HFrEF 的风险更密切相关。肥胖与 HFpEF 之间的风险差异在女性中似乎更为明显，这可能是心力衰竭亚型存在性别差异的原因。
