Clinician Article

Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies.

  • Aune D
  • Sen A
  • Norat T
  • Janszky I
  • Romundstad P
  • Tonstad S, et al.
Circulation. 2016 Feb 16;133(7):639-49. doi: 10.1161/CIRCULATIONAHA.115.016801. Epub 2016 Jan 8. (Review)
PMID: 26746176
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  • Endocrine
    Relevance - 7/7
    Newsworthiness - 5/7
  • Cardiology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Public Health
    Relevance - 6/7
    Newsworthiness - 5/7
  • Special Interest - Obesity -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 3/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 4/7


BACKGROUND: Obesity has been associated with increased risk of heart failure, but whether overweight also increases risk is unclear. It is also unclear whether abdominal adiposity is more strongly associated with heart failure risk than general adiposity. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relationship between general and abdominal adiposity and the risk of heart failure.

METHODS AND RESULTS: PubMed and Embase databases were searched up to October 10, 2014. Summary relative risks were calculated using random-effects models. A total of 28 studies (27 publications) were included. Twenty-three prospective studies with >15 905 incident cases among 647 388 participants were included in the analysis of body mass index and heart failure incidence, and 4 studies were included for heart failure mortality. The summary relative risk for a 5-unit increment in body mass index was 1.41 (95% confidence interval, 1.34-1.47; I(2)=83%) for heart failure incidence and 1.26 (95% confidence interval, 0.85-1.87; I(2)=95%) heart failure mortality. Although the test for nonlinearity was significant (P<0.0001), this appeared to be attributable to a threshold at a body mass index of ˜23 to 24 kg/m(2); however, there was evidence of increased risk even in the overweight body mass index range. The summary relative risk for a 10-cm increase in waist circumference was 1.29 (95% confidence interval, 1.21-1.37; I(2)=89%) and per 0.1-unit increase in waist-to-hip ratio was 1.29 (95% confidence interval, 1.13-1.47; I(2)=82%).

CONCLUSION: Overweight and obesity and abdominal adiposity are associated with increased risk of heart failure.

Clinical Comments


This is an important study with clear clinical implications. Overweight and abdominal obesity are not only risk factors for Coronary Artery Disease but also for Heart Failure.


Very informative metanalysis of multiple measures of adiposity in relation to risk of heart failure incidence and mortality.


While the information gathered here and analyzed is available piecemeal to everyone, this is an impressive and convincing meta-analysis.The numbers, meticulous assessment and cautious conclusions warrant reading by everyone dealing with adults who are overweight, obese, or have heart failure. While we are aware of the individual dangers of overweight and obesity [diabetes, limited exercise tolerance, possibly osteoarthritis, pulmonary difficulties, etc.] this study gives us an outcome with the implied [not yet proven as I read the review] message that prevention of overweight and/or treatment of this may result in dramatic improvement of heart failure and mortality [the next study needed]. We all sort of felt this but this puts an exclamation point on the need to attack overweight and obesity on a patient by patient basis in our own practices and not wait for national guidelines and education to do this difficult job.--Good job!!

General Internal Medicine-Primary Care(US)

The last line in the conclusion section should refer to the impact on mortality.

General Internal Medicine-Primary Care(US)

This article reinforces to patients that "overweight" is not necessarily healthy or without risk. The authors rightly point out more study needed to better elucidate the relationship between obesity, overweight and adiposity in heart failure independent of other common risk factors.

Public Health

The consistency of the direction of the association across studies and sub-groups clearly shows that maintaining optimal weight may prevent incident heart failure. While overweight also is associated with such events, the lack of repeated anthropometric measurements makes it difficult to know if overweight subjects subsequently became obese and hence developed incident heart failure. Despite lacking longitudinal measurements, such data would guide societies to support policies towards better health.

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