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Clinical Research

Association of metabolically healthy obesity with risk of heart failure and left ventricular dysfunction among older adults

International Journal of Obesity volume 48, pages 1587–1592 (2024)Cite this article

Subjects

Abstract

Background

Obesity is major cause of heart failure (HF), but it is related with a better prognosis among the elderly. Therefore, we aimed to examine whether metabolically healthy obesity (MHO) in late life increases HF risk and is reflected in impaired left ventricular (LV) function.

Methods

The participants were grouped into four metabolic phenotypes based on obesity and metabolic status: metabolically healthy non-obesity (MHN), MHO, metabolically unhealthy non-obesity (MUN), metabolically unhealthy obesity (MUO). Association of metabolic phenotypes with LV function was evaluated using multiple linear regression models. And association between metabolic phenotypes and risk of HF was assessed using multivariable logistic regression models. In addition, we validated the association of metabolic phenotypes and HF risk in a separate longitudinal cohort.

Results

In the primary cohort of 6335 participant, there were 434 participants diagnosed with HF. Compared to MHN participants, the risk of HF was higher among older individuals with MUN (OR = 1.51 [95% CI: 1.14–1.99]) and MUO (OR = 2.01 [95% CI: 1.39–2.91]), but not older individuals with MHO (OR = 0.86 [95% CI: 0.30–2.43). Regarding to LV function, worse LV diastolic function was noted among MUN and MUO individuals rather than MHO individuals. Older adults with MHO were also not associated with risk of HF in the validation cohort.

Conclusion

Among older individuals, the metabolic health status might modify the association of obesity with risk of HF and LV diastolic dysfunction. Worse LV diastolic function and higher risk of HF were just noted in individuals with MUO, but not in those with MHO.

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Fig. 1: Association of metabolic phenotypes with left ventricular function.
Fig. 2
Fig. 3: Cumulative incidence of incident heart failure by metabolic phenotypes in validation cohort.

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Data availability

The data used and/or analyzed in this study are available to all researchers upon reasonable request.

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Acknowledgements

We thank all the staff and participants of the RED-CARPET study and ARIC study for their contributions.

Funding

This study was supported by the National Natural Science Foundation of China (81870195, 82070384 to XL; 81900329 to YG), Guangdong Basic and Applied Basic Research Foundation (2019A1515011582, 2021A1515011668 to XL; 2019A1515011098, 2022A1515010416 to YG; 2022A1515111181 to ML; 2021A1515110266 to ZX) and China Postdoctoral Science Foundation (2022M723635 to ML; 2021TQ0386, 2021M703738 to ZX).

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Author notes

  1. These authors contributed equally: Peng Wang, Menghui Liu.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Peng Wang, Menghui Liu, Shaozhao Zhang, Yue Guo, Zhenyu Xiong, Yiquan Huang, Xiaojie Cai, Lixiang He, Zhuohui Chen, Yi Zhou, Xiaodong Zhuang & Xinxue Liao

  2. NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat-sen University), Guangzhou, China

    Peng Wang, Menghui Liu, Shaozhao Zhang, Yue Guo, Zhenyu Xiong, Yiquan Huang, Xiaojie Cai, Lixiang He, Zhuohui Chen, Yi Zhou, Xiaodong Zhuang & Xinxue Liao

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  1. Peng Wang
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Contributions

XL, XZ, PW and ML conceived and designed the study. XL, XZ, PW, ML, SZ, YG, ZX, YH, XC, LH, ZC and YZ contributed to the acquisition, analysis and interpretation of the data. PW and ML were responsible for writing the manuscript. All authors contributed to revising the manuscript draft for important intellectual content and approved the final submitted manuscript.

Corresponding authors

Correspondence to Xiaodong Zhuang or Xinxue Liao.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was followed the principles of the Declaration of Helsinki and was approved by the ethics committee (ChiCTR2000039901 and NCT00005131). Written informed consent was obtained from all participants prior to data collection.

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Wang, P., Liu, M., Zhang, S. et al. Association of metabolically healthy obesity with risk of heart failure and left ventricular dysfunction among older adults. Int J Obes 48, 1587–1592 (2024). https://doi.org/10.1038/s41366-024-01587-3

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