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Increased Waist Size Linked to Heart Failure

Higher waist size is associated with heart failure (HF) in women at all levels of body mass index (BMI), and both waist size and BMI predicted HF in men, according to the results of a study.

Emily B. Levitan, ScD, from Beth Israel Deaconess Medical Center in Boston, Massachusetts, writes,  “Obesity is associated with [HF] incidence…. We examined the strength of the association of [BMI] with HF by age and joint associations of BMI and waist circumference (WC).”

The study sample consisted of 36,873 women aged 48 to 83 years and 43,487 men aged 45 to 79 years. Height, weight, and WC were self-reported, and administrative registers allowed determination of HF hospitalization or death, which occurred in 382 women and 718 men, between January 1, 1998, and December 31, 2004.

For an interquartile range higher BMI, HRs were 1.39 (95% confidence interval [CI], 1.15 – 1.68) at age 60 years and 1.13 (95% CI, 1.02 – 1.27) at age 75 years in women. At the same ages in men, HRs were 1.54 (95% CI, 1.37 – 1.73) and 1.25 (95% CI, 1.16 – 1.35), respectively.

Among women with BMIs of 25 kg/m2 and 30 kg/m2, a 10-cm higher WC was associated with 15% (95% CI, 2% – 31%) and 18% (95% CI, 4% – 33%) higher rates of HF, respectively. For WCs of 70 and 100 cm, HRs for 1-kg/m2 higher BMI were 1.00 (95% CI, 0.96 – 1.04) and 1.01 (95% CI, 0.98 – 1.04), respectively.

Among men, a 10-cm higher WC was associated with 16% and 18% higher rates for BMI of 25 kg/m2 and 30 kg/m2, respectively. Regardless of WC, a 1-kg/m2 higher BMI was associated with 4% higher HF rates.

“Strength of the association between BMI and HF events declined with age,” the study authors write. “In women, higher WC was associated with HF at all levels of BMI. Both BMI and WC were predictors among men.”

Limitations of this study include lack of detailed clinical data on the study population; lack of generalizability to HF treated exclusively on an outpatient basis; inability to determine HF etiology or to differentiate between HF with impaired or preserved systolic function; possible overdiagnosis of HF in obese people because of dyspnea and edema related to obesity; less accuracy of self-reported height, weight, hip circumference, and WC than of clinically measured anthropometrics; and possible residual confounding.

“We found that measures of both overall and abdominal adiposity were associated with HF hospitalization or mortality in this middle-aged and older population,” the study authors conclude.

Circ Heart Fail. Published online April 7, 2009.