Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship With Obesity. The MESA (Multi-Ethnic Study of Atherosclerosis) Study

Hossein Bahrami, David A. Bluemke, Richard Kronmal, Alain G. Bertoni, Donald M. Lloyd-Jones, Eyal Shahar, Moyses Szklo, João A C Lima

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Abstract

Objectives: The objectives of this study were to determine the associations of the metabolic syndrome, inflammatory markers, and insulin resistance with incident congestive heart failure (CHF), beyond established risk factors, and to examine whether these risk factors may provide the link between obesity and CHF. Background: Recently, increasing interest has emerged on the potential role of novel risk factors such as systemic inflammation, insulin resistance, and albuminuria in the pathophysiology of CHF and their relationship with obesity. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a community-based multicenter cohort study of 6,814 participants (age 45 to 84 years, 3,601 women) of 4 ethnicities: Caucasians, African Americans, Hispanics, and Chinese Americans. Participants were recruited between 2000 and 2002 from 6 U.S. communities. Median follow-up time was 4 years. Participants with history of symptomatic cardiovascular disease were excluded. Cox proportional hazards models were used to analyze the associations of the metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria with incident CHF, independent of established risk factors (age, gender, hypertension, diabetes mellitus, left ventricular hypertrophy, obesity, serum total cholesterol, and smoking), an interim myocardial infarction, and baseline magnetic resonance imaging parameters of left ventricular structure and function. Results: A total of 79 participants developed CHF during follow-up, and 26 participants (32.9%) had a myocardial infarction prior to CHF and 65% of the cases had CHF with preserved function (left ventricular ejection fraction ≥40%). In multivariable analyses, serum interleukin-6 (hazard ratio [HR] for 1 standard deviation 1.50, 95% confidence interval [CI] 1.10 to 2.03) or C-reactive protein (HR for 1 standard deviation 1.38; 95% CI 1.01 to 1.86) and macroalbuminuria (HR 4.31, 95% CI 1.58 to 11.76) were predictors of CHF, independent of obesity and the other established risk factors. Although obesity was significantly associated with incident CHF, this association was no longer significant after adding inflammatory markers (interleukin-6 or C-reactive protein) to the model. Conclusions: Inflammatory markers and albuminuria are independent predictors of CHF. The association of obesity and CHF may be related to pathophysiologic pathways associated with inflammation.

Original languageEnglish (US)
Pages (from-to)1775-1783
Number of pages9
JournalJournal of the American College of Cardiology
Volume51
Issue number18
DOIs
StatePublished - May 6 2008

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Atherosclerosis
Heart Failure
Obesity
Albuminuria
Insulin Resistance
Confidence Intervals
C-Reactive Protein
Interleukin-6
Myocardial Infarction
Inflammation
Asian Americans
Left Ventricular Hypertrophy
Serum
Left Ventricular Function
Hispanic Americans
Proportional Hazards Models
African Americans
Stroke Volume
Multicenter Studies
Diabetes Mellitus

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship With Obesity. The MESA (Multi-Ethnic Study of Atherosclerosis) Study. / Bahrami, Hossein; Bluemke, David A.; Kronmal, Richard; Bertoni, Alain G.; Lloyd-Jones, Donald M.; Shahar, Eyal; Szklo, Moyses; Lima, João A C.

In: Journal of the American College of Cardiology, Vol. 51, No. 18, 06.05.2008, p. 1775-1783.

Research output: Contribution to journalArticle

Bahrami, Hossein ; Bluemke, David A. ; Kronmal, Richard ; Bertoni, Alain G. ; Lloyd-Jones, Donald M. ; Shahar, Eyal ; Szklo, Moyses ; Lima, João A C. / Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship With Obesity. The MESA (Multi-Ethnic Study of Atherosclerosis) Study. In: Journal of the American College of Cardiology. 2008 ; Vol. 51, No. 18. pp. 1775-1783.
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abstract = "Objectives: The objectives of this study were to determine the associations of the metabolic syndrome, inflammatory markers, and insulin resistance with incident congestive heart failure (CHF), beyond established risk factors, and to examine whether these risk factors may provide the link between obesity and CHF. Background: Recently, increasing interest has emerged on the potential role of novel risk factors such as systemic inflammation, insulin resistance, and albuminuria in the pathophysiology of CHF and their relationship with obesity. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a community-based multicenter cohort study of 6,814 participants (age 45 to 84 years, 3,601 women) of 4 ethnicities: Caucasians, African Americans, Hispanics, and Chinese Americans. Participants were recruited between 2000 and 2002 from 6 U.S. communities. Median follow-up time was 4 years. Participants with history of symptomatic cardiovascular disease were excluded. Cox proportional hazards models were used to analyze the associations of the metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria with incident CHF, independent of established risk factors (age, gender, hypertension, diabetes mellitus, left ventricular hypertrophy, obesity, serum total cholesterol, and smoking), an interim myocardial infarction, and baseline magnetic resonance imaging parameters of left ventricular structure and function. Results: A total of 79 participants developed CHF during follow-up, and 26 participants (32.9{\%}) had a myocardial infarction prior to CHF and 65{\%} of the cases had CHF with preserved function (left ventricular ejection fraction ≥40{\%}). In multivariable analyses, serum interleukin-6 (hazard ratio [HR] for 1 standard deviation 1.50, 95{\%} confidence interval [CI] 1.10 to 2.03) or C-reactive protein (HR for 1 standard deviation 1.38; 95{\%} CI 1.01 to 1.86) and macroalbuminuria (HR 4.31, 95{\%} CI 1.58 to 11.76) were predictors of CHF, independent of obesity and the other established risk factors. Although obesity was significantly associated with incident CHF, this association was no longer significant after adding inflammatory markers (interleukin-6 or C-reactive protein) to the model. Conclusions: Inflammatory markers and albuminuria are independent predictors of CHF. The association of obesity and CHF may be related to pathophysiologic pathways associated with inflammation.",
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AU - Kronmal, Richard

AU - Bertoni, Alain G.

AU - Lloyd-Jones, Donald M.

AU - Shahar, Eyal

AU - Szklo, Moyses

AU - Lima, João A C

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N2 - Objectives: The objectives of this study were to determine the associations of the metabolic syndrome, inflammatory markers, and insulin resistance with incident congestive heart failure (CHF), beyond established risk factors, and to examine whether these risk factors may provide the link between obesity and CHF. Background: Recently, increasing interest has emerged on the potential role of novel risk factors such as systemic inflammation, insulin resistance, and albuminuria in the pathophysiology of CHF and their relationship with obesity. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a community-based multicenter cohort study of 6,814 participants (age 45 to 84 years, 3,601 women) of 4 ethnicities: Caucasians, African Americans, Hispanics, and Chinese Americans. Participants were recruited between 2000 and 2002 from 6 U.S. communities. Median follow-up time was 4 years. Participants with history of symptomatic cardiovascular disease were excluded. Cox proportional hazards models were used to analyze the associations of the metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria with incident CHF, independent of established risk factors (age, gender, hypertension, diabetes mellitus, left ventricular hypertrophy, obesity, serum total cholesterol, and smoking), an interim myocardial infarction, and baseline magnetic resonance imaging parameters of left ventricular structure and function. Results: A total of 79 participants developed CHF during follow-up, and 26 participants (32.9%) had a myocardial infarction prior to CHF and 65% of the cases had CHF with preserved function (left ventricular ejection fraction ≥40%). In multivariable analyses, serum interleukin-6 (hazard ratio [HR] for 1 standard deviation 1.50, 95% confidence interval [CI] 1.10 to 2.03) or C-reactive protein (HR for 1 standard deviation 1.38; 95% CI 1.01 to 1.86) and macroalbuminuria (HR 4.31, 95% CI 1.58 to 11.76) were predictors of CHF, independent of obesity and the other established risk factors. Although obesity was significantly associated with incident CHF, this association was no longer significant after adding inflammatory markers (interleukin-6 or C-reactive protein) to the model. Conclusions: Inflammatory markers and albuminuria are independent predictors of CHF. The association of obesity and CHF may be related to pathophysiologic pathways associated with inflammation.

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