Obesity in Middle Age Increases Risk of Later Heart Failure in Women—Results From the Prospective Population Study of Women and H70 Studies in Gothenburg, Sweden

The Impact of Idiopathic Intracranial Hypertension on Cardiovascular Disease Risk Among UK Women: An Obesity-Adjusted Analysis

Introduction

Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.

Methods

An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.

Results

The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.

Conclusions

This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.

Disparities in prevalence of heart failure between the genders in relation to age, multimorbidity and socioeconomic status in southern Sweden: a cross-sectional study

OBJECTIVE

Prior studies have reported that heart failure typically affects elderly, multimorbid and socioeconomically deprived men. Women with heart failure are generally older, have a higher EF (ejection fraction) and have more heart failure-related symptoms than men. This study explored the disparities in the prevalence of heart failure between men and women in relation to age, multimorbidity level and socioeconomic status of the population in southern Sweden.

DESIGN

A register-based, cross-sectional cohort study.Setting and subjects: The inhabitants from 20 years of age onwards (N = 981,383) living in southern Sweden in 2015.Main outcome measure: Prevalence and mean probability of having heart failure in both genders. CNI (Care Need Index) percentiles depend on the socioeconomic status of their listed primary healthcare centres.

RESULTS

Men had a higher OR for HF - 1.70 (95% CI 1.65-1.75) - than women. The probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity levels. At all CNI levels, the multimorbid patients had a higher prevalence of heart failure in men than in women. The disparity in the mean probability of heart failure between the most affluent and deprived CNI percentile was more apparent in women compared to men, especially from 80 years.

CONCLUSIONS

The prevalence of heart failure differs significantly between the genders. Men had an increasing mean probability of heart failure with advancing age and multimorbidity level compared to women. Socioeconomic deprivation was more strongly associated with heart failure in women than in men. The probability of having heart failure differs between the genders in several aspects.Key PointsIndependently of socioeconomic status, men had a higher prevalence of heart failure than women among the multimorbid patients.The mean probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity level.Socioeconomic status was more strongly associated with heart failure in women than in men.

Relationship between body roundness index and the risk of heart failure in Chinese adults: the Kailuan cohort study

AIMS

Body roundness index (BRI) is an obesity-related anthropometric index that combines waist circumference and height to better reflect body fat. This study aims to prospectively explore the relationship between BRI and the risk of heart failure (HF) based on a community-based cohort.

METHODS AND RESULTS

A total of 140 362 individuals without tumour and HF at baseline were included from the Kailuan cohort study. Their demographic information, anthropometric parameters, and biochemical indexes were collected or measured. The participants were followed up until 31 December 2016 or death or diagnosed with HF, whichever came first. Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident HF. Restricted cubic spline analysis was applied to further evaluate the possible non-linear dose-response relationship between BRI and the risk of HF. After a median follow-up period of 9.84 years, we identified 1990 HF events. The participants were grouped into four groups according to the quartiles of BRI (Q1: ≤2.93, Q2: 2.93-3.59, Q3: 3.59-4.38, and Q4: ≥4.38). After adjustment for potential confounders, compared with the group of participants in the lowest quartile of BRI, the adjusted HRs (95%CI) were 1.03 (95%CI: 0.87-1.22), 1.27 (95%CI: 1.07-1.49), and 1.50 (95%CI: 1.26-1.78) for subjects in the Q2, Q3, and Q4 groups, respectively. With each standard deviation (here is 1.10) of BRI increasing, the risk of HF increased by 18% (HR: 1.18, 95%CI: 1.12-1.24). Subgroup analysis indicated that the association between BRI and HF was more prominent in younger people (HR: 2.94, 95%CI: 1.80-4.80) than older (HR: 1.89, 95%CI: 1.57-2.27) (P for interaction < 0.001). A significant linear dose-response relationship between BRI and HF was also observed (P for non-linearity = 0.730).

CONCLUSIONS

Our study suggests that higher BRI is associated with an increased risk of HF. If these findings can be replicated in other populations, future studies need to examine whether lowering the BRI may lower the risk of incident HF.

Disparities in prevalence of heart failure according to age, multimorbidity level and socioeconomic status in southern Sweden: a cross-sectional study

OBJECTIVE

The aim of this study was to compare the prevalence of heart failure (HF) in relation to age, multimorbidity and socioeconomic status of primary healthcare centres in southern Sweden.

DESIGN

A cross-sectional study.

SETTING

The data were collected concerning diagnoses at each consultation in all primary healthcare centres and secondary healthcare in the southernmost county of Sweden at the end of 2015.

PARTICIPANTS

The individuals living in southern Sweden in 2015 aged 20 years and older. The study population of 981 383 inhabitants was divided into different categories including HF, multimorbidity, different levels of multimorbidity and into 10 CNI (Care Need Index) groups depending on the socioeconomic status of their listed primary healthcare centre.

OUTCOMES

Prevalence of HF was presented according to age, multimorbidity level and socioeconomic status. Logistic regression was used to further analyse the associations between HF, age, multimorbidity level and socioeconomic status in more complex models.

RESULTS

The total prevalence of HF in the study population was 2.06%. The prevalence of HF increased with advancing age and the multimorbidity level. 99.07% of the patients with HF fulfilled the criteria for multimorbidity. The total prevalence of HF among the multimorbid patients was only 5.30%. HF had a strong correlation with the socioeconomic status of the primary healthcare centres with the most significant disparity between 40 and 80 years of age: the prevalence of HF in primary healthcare centres with the most deprived CNI percentile was approximately twice as high as in the most affluent CNI percentile.

CONCLUSION

The patients with HF were strongly associated with having multimorbidity. HF patients was a small group of the multimorbid population associated with socioeconomic deprivation that challenges efficient preventive strategies and health policies.

Cholesterol and triglyceride levels in midlife and risk of heart failure in women, a longitudinal study: the prospective population study of women in Gothenburg

OBJECTIVE

To examine the association between triglycerides and cholesterol serum values and risk of developing heart failure in women.

DESIGN

Longitudinal observational study of four cohorts 50-year-old women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005, and followed until 2012. S-triglycerides and s-cholesterol were measured at baseline and heart failure morbidity and mortality data collected from 1980 to 2012.

SETTING

Prospective population study Gothenburg, Sweden. Primary care.

PARTICIPANTS

1143 women 50 year old without history of heart failure or myocardial infarction.

MAIN OUTCOME MEASURE

Association among s-triglycerides, s-cholesterol and heart failure expressed as HR for heart failure, adjusted for smoking, body mass index (BMI), physical activity and age.

RESULTS

For 50-year-old women examined in 1968-1969, there was an independent association between level of s-triglycerides and heart failure and a significantly higher risk of developing heart failure (HR 1.8; CI 1.16 to 2.80, for each increment of 1.0 mmol/L in s-triglycerides), adjusted for smoking, BMI, physical activity and age. There was no significant association between s-cholesterol and risk of heart failure (HR 0.9; CI 0.77 to 1.15). In the cohorts of 50-year-old women examined in 1980 and 1992, there were no significant associations between neither s-triglycerides or s-cholesterol and the risk of heart failure. In the pooled analyses of the cohorts examined in 1968, 1980 and 1992, a significantly increased risk of heart failure was found (HR 1.49; CI 1.10 to 2.03) for s-triglycerides independently, but not for s-cholesterol. None of the 50-year-old women examined in 2004-2005 developed heart failure by 2012 and were excluded from further analyses.

CONCLUSIONS

High levels of s-triglycerides but not s-cholesterol may be a risk marker for later development of heart failure in 50-year-old women.

Impact of changes in physical activity or BMI on risk of heart failure in women - the prospective population study of women in Gothenburg

Objective: To longitudinally evaluate the impact of change in physical activity or change in body mass index (BMI) over time on the risk of developing heart failure (HF) in women without a previous diagnosis of HF.Design and setting: Longitudinal, observational, prospective study of women in Gothenburg, Sweden. Data on BMI and level of physical activity were collected from examinations 1968-1992 and hospital diagnoses and mortality data were ascertained from 1980 to 2012.Subjects: Data were obtained from 1749 women included in the Prospective Population Study of Women in Gothenburg.Main outcome measures: Hazard ratio (HR) for HF was calculated, using a Cox regression model.Results: Women with stable high physical activity during 1968-1980 and 1980-1992 reduced their risk of subsequent HF compared to the non-active women (for 1968-1980 HR 0.66, 95% Confidence Interval (CI) 0.44-0.99 and for 1980-1992 HR 0.47, 95% CI 0.29-0.74). Women with increasing levels of physical activity during 1980-1992 reduced their risk of HF compared to the non-active women (HR 0.40, 95% CI 0.22-0.72). Increase in BMI from overweight to obesity during 1968-1980 predicted increased risk of developing HF (HR 1.93, 95% CI 1.18-3.14).Conclusions: Reduced risk of future HF in healthy women may be achieved by remaining physically active from young middle age and throughout life or by increasing the level of physical activity. This is particularly important for sedentary women in middle age. The role of physical activity in preventing the development of obesity must be taken into account.Key pointsA sedentary lifestyle and obesity are risk factors for developing heart failure (HF) in women.The risk of developing HF may be reduced by increasing the level of activity in sedentary middle-aged women.For younger women, avoiding obesity is most important to reduce the risk of later HF.Primary care has a key role in guiding women towards the most effective lifestyle changes to prevent development of HF.

Body Mass Index in Young Women and Risk of Cardiomyopathy: A Long-Term Follow-Up Study in Sweden

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Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy.

Body mass index in women aged 18 to 45 and subsequent risk of heart failure

BACKGROUND

The incidence of heart failure (HF) is decreasing in older ages, but increasing rates have been observed among younger persons in Sweden. Therefore, we investigated the relationship between risk of hospitalization for HF and body mass index (BMI).

METHODS

This was a prospective registry-based cohort study. We included 1,374,031 women aged 18-45 years (mean age 27.9 years) who gave birth during 1982-2014, and were registered in the Medical Birth Register. Information on hospitalization because of HF was collected through linkage to the National Inpatient Register.

RESULTS

Compared to women with a BMI of 20-<22.5 kg/m², women with a BMI of 22.5-<25.0 had a hazard ratio (HR) of 1.24 (95% confidence interval (CI), 1.10-1.39) for HF after adjustment for age, year, parity, baseline disorders, smoking, and education. The HR (95% CI) increased to 1.56 (1.36-1.78), 2.39 (2.05-2.78), 2.82 (2.43-3.28), and 4.51 (3.63-5.61) in women with a BMI of 25-<27.5, 27.5-<30, 30-<35, and ≥35 kg/m², respectively. The multiple-adjusted HRs (95% CI) associated with risk of HF per one-unit increase in BMI in women with a BMI ≥ 22.5 kg/m² ranged from 1.01 (0.97-1.06) for HF related to valvular disease to 1.14 (1.12-1.15) for coronary heart disease, diabetes, or hypertension.

CONCLUSION

Increasing body weight was strongly associated with the risk of early HF in women. Compared with lean women, the risk for HF started to increase at high-normal BMI levels, and was nearly five-fold in women with a BMI ≥ 35 kg/m².