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People with a higher body mass index, waist-to-hip ratio, or waist size have an increased risk of developing heart failure

Aune D, Sen A, Norat T, et al. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016;133:639-49.

Review question

If you are overweight or obese, are you at higher risk of developing heart failure?

Background

Heart failure occurs when your heart can’t pump blood well enough to meet the needs of your body. People who are obese may develop chronic diseases such as heart failure.

Measures to assess your body weight and body fat include body mass index (BMI)*, waist-to-hip ratio (WHR), and waist size. People with a BMI of 25 to less than 30 are considered overweight. Those with a BMI of 30 or over are considered obese. Different measures of body weight and body fat may help your doctor assess your risk of developing heart failure.

*BMI = (your weight in kg/[your height in meters × your height in meters]) or 703 × (your weight in pounds/[your height in inches × your height in inches]).

The research

There were 28 prospective studies that were published in English up to October 2014.

The studies included almost 900,000 men and women, most over 40 years of age and most from Europe or the USA.

Studies measured people’s BMI, WHR, or waist size and then followed them to see if they developed heart failure or died from heart failure. People were followed for as little as 1 year and as many as 27 years.

Studies done only in people with diabetes or impaired glucose tolerance were excluded.

What the researchers found

Men with a WHR of 1.00 or more or waist size of 100 cm (39 inches) or more were more likely to develop heart failure than those with a smaller WHR or waist size. Women with a WHR of 0.75 or more or waist size of 75 cm (29.5 inches) or more were more likely to develop heart failure than those with a smaller WHR or waist size.

The higher the WHR or waist size, the greater the risk of developing heart failure.

People with a BMI of 25 or more were more likely to develop heart failure than other people.

The higher the BMI, the greater the risk for developing heart failure.

People with a BMI of 27.5 or more were at greater risk of dying from heart failure than people with BMI of more than 20 but less than 27.5.

Of interest, you can also be “too thin”. People with a BMI less than 17.5 were more likely to develop heart failure than people in the middle range of BMI.

Conclusions

People with a higher waist-to-hip ratio or waist size have an increased risk of developing heart failure. People with a very low (under 17.5) or high (25 and above) body mass index have an increased risk of developing heart failure.

Associations between high weight or fat measures and developing heart failure after 1 to 27 years

Weight or fat measure

Outcomes

Number of studies and people

Results

Body mass index (BMI)†

Heart failure

23 studies (647,388 people)

2.5% of people developed heart failure.

People with BMI of 25 or more were more likely to develop heart failure than people with BMI less than 25.‡

For each 5-point increase in BMI, the relative risk of developing heart failure in men or women increased by 41% (from as little as 34% to as much as 47%).

 

Death due to heart failure

4 studies (215,657 people)

0.47% of people died due to heart failure

People with BMI of 27.5 or more were at greater risk for dying from heart failure than people with BMI of more than 20 but less than 27.5.

Waist-to-hip ratio (WHR)

Heart failure

6 studies (186,458 people)

4.1% of people developed heart failure.

Men with WHR of 1.00 or more and women with WHR of 0.75 or more were more likely to develop heart failure than people with a smaller WHR.

For each 0.1-unit increase in WHR, the relative risk of developing heart failure in men or women increased by 28% (from as little as 12% to as much as 47%).

Waist size

Heart failure

12 studies (362,450 people)

2.7% of people developed heart failure.

Men with waist size 100 cm (39 in) or more, and women with waist size 75 cm (29.5 in) or more were more likely to develop heart failure than people with a smaller waist size.

For each 10-cm increase in waist size, the relative risk of developing heart failure in men or women increased by 29% (from as little as 21% to as much as 37%).

†Body mass index = (your weight in kg/[your height in meters × your height in meters]) or 703 × (your weight in pounds/[your height in inches × your height in inches]).

‡You can also be “too thin”. People with BMI less than 17.5 were more likely to develop heart failure than people in the middle range of BMI.



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