Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
J Health Popul Nutr. 2024 Feb 29;43(1):33. doi: 10.1186/s41043-024-00530-6.
In Thailand, the epidemiological data on the relationship between obesity and heart failure (HF) among high-risk populations was limited. We assessed the association between body mass index (BMI) and the new-onset HF among people with hypertension (HTN), and also assessed the effect modifier of uncontrolled HTN on this association.
We analyzed the data obtained from the 2018 Thailand DM/HT study database. Thai people with HTN aged 20 years and older receiving continuous care at outpatient clinics in hospitals nationwide were included. The new-onset HF was defined regarding the ICD-10 as I50 in the medical records within 12 months. Obesity was defined as BMI 25 kg/m. Multivariable log-binomial regression analysis was used to determine the association between BMI and new-onset HF and presented as the adjusted risk ratio (aRR) and 95% confidence interval (CI).
A total of 35,756 participants were included in the analysis. In all, 50.0% of the participants had BP control for the last two consecutive visits. The mean BMI was 25.1 4.7 kg/m. New-onset HF occurred in 75 participants (0.21%; 95% CI 0.17-0.26). After adjusting for potential confounders, an elevated BMI was associated with new-onset HF (p value for quadratic trend < 0.001). In comparison with participants with normal BMI (18.5-22.9 kg/m), the aRR for new-onset HF was 1.57 (95% CI 0.80-3.07) and 3.97 (95% CI 1.95-8.10) in those with BMI 25.0-29.9, and ≥ 30.0 kg/m. For participants with obesity, aRR for new-onset HF was 2.05 (95% CI 1.24-3.39) compared to non-obese participants. The study found that among patients with control BP, obesity was associated with a higher risk of new-onset HF with an adjusted RR of 2.33 (95% CI 1.12-4.83). For those with uncontrolled BP, the adjusted RR was 1.83 (95% CI 0.93-3.58), but there was no heterogeneity with p value = 0.642.
An increased BMI had a higher risk for new-onset HF among Thai people with HTN. Obesity was independently associated with new-onset HF among people with HTN, regardless of uncontrolled HTN. Our findings highlight that weight reduction is crucial for mitigating the risk of HF development in HTN patients, regardless of their BP control status.
在泰国，关于高危人群中肥胖与心力衰竭（HF）之间关系的流行病学数据有限。我们评估了高血压（HTN）人群中体重指数（BMI）与新发 HF 之间的关系，并评估了未控制 HTN 对这种关系的影响修饰作用。
我们分析了 2018 年泰国 DM/HT 研究数据库中的数据。纳入了年龄在 20 岁及以上、在全国医院门诊接受连续治疗的泰国 HTN 患者。新发生的 HF 根据 ICD-10 在病历中定义为 12 个月内的 I50。肥胖定义为 BMI≥25kg/m。使用多变量二项式回归分析确定 BMI 与新发 HF 之间的关系，并表示为调整后的风险比（aRR）和 95%置信区间（CI）。
共有 35756 名参与者纳入分析。在所有参与者中，50.0%的参与者在最近两次连续就诊时血压得到控制。平均 BMI 为 25.1±4.7kg/m。共有 75 名参与者（0.21%；95%CI 0.17-0.26）发生新发 HF。在调整了潜在混杂因素后，升高的 BMI 与新发 HF 相关（二次趋势检验的 p 值<0.001）。与 BMI 正常（18.5-22.9kg/m）的参与者相比，BMI 为 25.0-29.9kg/m 和≥30.0kg/m 的参与者发生新发 HF 的 aRR 分别为 1.57（95%CI 0.80-3.07）和 3.97（95%CI 1.95-8.10）。对于肥胖患者，新发 HF 的 aRR 为 2.05（95%CI 1.24-3.39），与非肥胖患者相比。研究发现，在血压控制良好的患者中，肥胖与新发 HF 的风险增加相关，调整后的 RR 为 2.33（95%CI 1.12-4.83）。对于血压未控制的患者，调整后的 RR 为 1.83（95%CI 0.93-3.58），但异质性检验的 p 值=0.642，无统计学意义。
泰国 HTN 患者 BMI 升高与新发 HF 的风险增加相关。肥胖与 HTN 患者新发 HF 独立相关，无论其 HTN 是否未得到控制。我们的研究结果表明，无论其血压控制状态如何，减轻体重对于降低 HTN 患者 HF 发展的风险都至关重要。
