Transitions in metabolic health status over time and risk of heart failure: A prospective study

Jianing Bi; Lulu Song; Lulin Wang; Binbin Su; Mingyang Wu; Dankang Li; Shuohua Chen; Yunyun Liu; Yingping Yang; Ziyi Zhou; Yonghua Hu; Youjie Wang; Shouling Wu; Yaohua Tian

doi:10.1016/j.diabet.2021.101266

Transitions in metabolic health status over time and risk of heart failure: A prospective study

Diabetes Metab. 2022 Jan;48(1):101266. doi: 10.1016/j.diabet.2021.101266. Epub 2021 Jul 9.

Authors

Jianing Bi¹, Lulu Song¹, Lulin Wang¹, Binbin Su², Mingyang Wu¹, Dankang Li¹, Shuohua Chen³, Yunyun Liu¹, Yingping Yang¹, Ziyi Zhou¹, Yonghua Hu⁴, Youjie Wang¹, Shouling Wu⁵, Yaohua Tian⁶

Affiliations

¹ Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Institute of Population Research, Peking University, Beijing, China.
³ Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan City, China.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁵ Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan City, China. Electronic address: drwusl@163.com.
⁶ Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: yaohua_tian@hust.edu.cn.

PMID: 34252500
DOI: 10.1016/j.diabet.2021.101266

Abstract

Aims: - Evidence for the effects of metabolically healthy obese (MHO) status on heart failure (HF) is limited and ignores the dynamic change of metabolic health and obesity phenotypes. We aimed to investigate the associations of metabolic health and its transition with HF across body mass index (BMI) and waist circumference (WC) categories.

Methods: - This prospective cohort study was conducted with 93,288 Chinese adults who were free of cardiovascular disease, cancer or HF at baseline (2006-2007). Metabolic health was defined as having no or only one abnormality in blood pressure, glucose, high-density lipoprotein cholesterol, or triglyceride levels. Participants were cross-classified at baseline by metabolic health and obesity (defined by BMI and WC criteria). Transitions in metabolic health status from 2006 to 2007 to 2010 to 2011 were considered. The hazard ratios (HRs) and 95% confidence intervals (CIs) for HF were assessed by Cox proportional hazards regression.

Results: - During a mean ± standard deviation follow-up of 9.7 ± 1.5 years, 1,628 participants developed HF. Individuals with MHO (HR: 1.78, 95% CI: 1.45, 2.19 for BMI criteria; HR: 1.51, 95% CI: 1.30, 1.76 for WC criteria) had higher risk of HF than those with metabolically healthy normal weight (MHNW). Individuals with initial MHO who shifted to metabolically unhealthy phenotype during follow-up had higher risk of HF compared with stable MHNW individuals (HR 3.12; 95% CI: 2.01, 4.85 for BMI categories; HR 1.98; 95% CI: 1.42, 2.77 for WC categories). Even stable MHO individuals were at an increased risk of HF compared with stable MHNW individuals (HR: 2.17; 95% CI: 1.39, 3.39 for BMI categories; HR: 1.33; 95% CI: 0.96, 1.85 for WC categories).

Conclusions: - MHO phenotype is dynamic and its transition to metabolically unhealthy phenotype or even stable MHO is associated with increased risk of HF. Maintaining metabolic health may provide a clue for preventing HF.

Keywords: Cohort study; Heart failure; Metabolic health; Transition.

MeSH terms

Body Mass Index
Health Status
Heart Failure* / epidemiology
Humans
Obesity, Metabolically Benign* / epidemiology
Phenotype
Prospective Studies
Risk Factors