Self-Reported Weight Provides Prognostic Information for Future Heart Failure Risk

Self-reported weight history by ethnically diverse middle-aged to older patients is independently provides prognostic information about future heart failure (HF) risk, according to a study published in the Journal of the American Heart Association.

Utilizing the MESA (Multi-Ethnic Study of Atherosclerosis) cohort of men and women aged 45 to 84 years without clinical atherosclerotic cardiovascular disease (ASCVD) or HF at baseline, investigators recruited participants (N=6437) of 4 race/ethnicities from 6 US communities: Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; New York, New York; Los Angeles County, California; and St. Paul, Minnesota, between 2000 and 2002.

Body mass indices (BMIs) were calculated using self-reported weights and measured height at baseline and at 4 follow-up examinations: Exam 2 (2002–2004), Exam 3 (2004–2005), Exam 4 (2005–2007), and Exam 5 (2010–2012).

Participants completed surveys indicating demographic and lifestyle factors (race/ethnicity, smoking status, educational attainment, etc.). Exercise and diet were scored using metabolic equivalent task-minutes of intentional moderate or vigorous exercise per week and by assessing adherence to a healthy diet, respectively.

Blood pressure was measured 3 times 1 minute apart with the second and third measurements averaged. Metabolic blood panels testing plasma glucose, triglycerides, and total and high-density lipoprotein cholesterol were measured from fasting blood samples.

Researchers also followed up with participants through telephone interviews every 9 to 12 months regarding interim hospital admissions, outpatient cardiovascular diagnoses and procedures, and deaths, and “[m]edical records were requested for those who reported being hospitalized or receiving an outpatient cardiovascular diagnosis. Records were obtained for 98% of cardiovascular events associated with hospitalization.”

At baseline, participants with BMI ≥30 kg/m2 had higher mean self-reported BMIs at both ages 20 and 40 years compared with participants with BMI ≤25 kg/m2.

Health conditions stemming from metabolic disease were predictably higher in the obese/overweight groups compared with the normal weight group. Higher BMIs and obesity status were strongly associated with incident HF after adjusting for covariates. Further analysis revealed that higher self-reported BMIs at age 20 and age 40 were still independently associated with incident HF (hazard ratio [HR] 1.27, 95% CI, 1.07–1.50 at age 20 years and HR 1.36 (95% CI, 1.18–1.57) at age 40 years, respectively, per 5 kg/m2 higher BMI). In comparison, associations of BMI at each age point were less strongly associated with ASCVD.

Limitations to the study include its observational nature, inherent bias in self-reported weights, height measurements taken later in life, and possible survival bias.

Although subject to recall bias, patients’ self-assessment of weight throughout decades of adulthood can better inform clinicians and patients about the risk of developing incident HF. Future research is warranted to determine how best to incorporate these self-assessments into clinical decision making.

Reference

Fliotsos M, Zhao D, Rao VN, et al. Body mass index from early‐, mid‐, and older‐adulthood and risk of heart failure and atherosclerotic cardiovascular disease: MESA [published online November 14, 2018]. Am Heart J. doi:10.1161/jaha.118.009599