Adiposity Measures and HFpEF Risk

Study Questions:

What is the association between measures of adiposity and risk for incident hospitalized heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF)?


The investigators studied 1,806 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) study without baseline cardiovascular disease who underwent anthropometrics (body mass index [BMI] and waist circumference) and an abdominal computed tomography (CT). Subcutaneous and visceral adipose tissue (VAT) were measured from a single CT slice at L2-L3. Cox hazard models were used to examine associations of adiposity with incident hospitalized HFpEF and HFrEF events. Fully adjusted models included demographics, HF risk factors, and N-terminal pro-B-type natriuretic peptide.


Over a mean follow-up of 11 years, there were 34 HFpEF and 36 HFrEF events. The fully adjusted hazard ratio (95% confidence interval [CI]) per 1-standard deviation (SD) higher of each anthropometric and CT-measured adiposity measures for incident HFpEF were as follows: BMI hazard ratio (HR), 1.66; 95% CI, 1.12-2.45; waist circumference HR, 1.59; 95% CI, 1.05-2.40; and VAT HR, 2.24; 95% CI, 1.44-3.49. None of these adiposity measures were associated with HFrEF. Even among overweight/obese adults (BMI ≥25 kg/m2), assessment of VAT (per 1-SD) was strongly associated with HFpEF (HR, 2.78; 95% CI, 1.62-4.76). Subcutaneous adipose tissue was neither associated with HFpEF nor HFrEF.


The authors concluded that CT-measured VAT was independently associated with incident hospitalized HFpEF, but not HFrEF.


This study reports that the anthropometric measures of BMI and waist circumference and the CT-measure of VAT were all strong risk factors for incident hospitalized HFpEF, but not HFrEF. These findings suggest a possible causal role of visceral fat in the pathogenesis of a phenotype of HFpEF. Additional studies are warranted to understand the optimal use of visceral adiposity markers to identify individuals at high risk of developing HF and strategies to modify this risk. At this time, physical exercise and caloric restriction, the only interventions shown to improve HFpEF by reducing VAT, should be encouraged in those with or at risk for HF, while studies directly targeting excess VAT with therapeutic agents are undertaken.

Clinical Topics: Anticoagulation Management, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Computed Tomography, Nuclear Imaging, Diet, Exercise

Keywords: Adipose Tissue, Adiposity, Body Mass Index, Caloric Restriction, Exercise, Heart Failure, Natriuretic Peptide, Brain, Obesity, Abdominal, Obesity, Overweight, Peptide Fragments, Primary Prevention, Risk Factors, Stroke Volume, Subcutaneous Fat, Abdominal, Tomography, X-Ray Computed, Waist Circumference

< Back to Listings