Heart Failure in Women: Risk Across a Woman's Adult Life

Association between waist-hip ratio and subclinical myocardial injury in the general population: Insights from the NHANES

BACKGROUND

Although studies have shown that higher waist-hip ratio (WHR) is closely related to higher risk of metabolism-related diseases, the relationship between WHR and subclinical myocardial injury (SC-MI) is unknown. This study was to evaluate the effect of WHR on SC-MI in the general population free from cardiovascular disease.

METHODS

The cross-sectional study included 6253 participants without cardiovascular disease (CVD) from the third National Health and Nutrition Examination Survey (NHANES III) for further analysis. Restricted cubic spline, multivariable logistic regression models and subgroup analyses were performed to assess the association between WHR and SC-MI.

RESULTS

The multivariate logistic regression showed that after adjusting for potential confounding factors, participants in the higher quartiles had higher risk of developing SC-MI than those in the first quartile of WHR [Q3, OR (95% CI): 1.523 (1.159, 2.000), P = 0.002; Q4, OR (95% CI): 1.719 (1.279, 2.311), P < 0.001], and this relationship was robust among the participants aged ≥ 50 years, with hypertension and without diabetes. Every 0.1 unit increase in WHR, as a continuous variable, increased the risk of SC-MI by more than 20% [OR (95% CI): 1.233 (1.092, 1.392), P = 0.001]. And restricted cubic spline analysis showed that there was a linear positive correlation between WHR and the risk of SC-MI.

CONCLUSIONS

WHR may be an independent risk factor for SC-MI in the general population free from CVD.

Transitions in metabolic health status over time and risk of heart failure: a prospective study

AIMS

- Evidence for the effects of metabolically healthy obese (MHO) status on heart failure (HF) is limited and ignores the dynamic change of metabolic health and obesity phenotypes. We aimed to investigate the associations of metabolic health and its transition with HF across body mass index (BMI) and waist circumference (WC) categories.

METHODS

- This prospective cohort study was conducted with 93,288 Chinese adults who were free of cardiovascular disease, cancer or HF at baseline (2006-2007). Metabolic health was defined as having no or only one abnormality in blood pressure, glucose, high-density lipoprotein cholesterol, or triglyceride levels. Participants were cross-classified at baseline by metabolic health and obesity (defined by BMI and WC criteria). Transitions in metabolic health status from 2006-2007 to 2010-2011 were considered. The hazard ratios (HRs) and 95% confidence intervals (CIs) for HF were assessed by Cox proportional hazards regression.

RESULTS

- During a mean ± standard deviation follow-up of 9.7 ± 1.5 years, 1,628 participants developed HF. Individuals with MHO (HR: 1.78, 95% CI: 1.45, 2.19 for BMI criteria; HR: 1.51, 95% CI: 1.30, 1.76 for WC criteria) had higher risk of HF than those with metabolically healthy normal weight (MH-NW). Individuals with initial MHO who shifted to metabolically unhealthy phenotype during follow-up had higher risk of HF compared with stable MH-NW individuals (HR 3.12; 95% CI: 2.01, 4.85 for BMI categories; HR 1.98; 95% CI: 1.42, 2.77 for WC categories). Even stable MHO individuals were at an increased risk of HF compared with stable MH-NW individuals (HR: 2.17; 95% CI: 1.39, 3.39 for BMI categories; HR: 1.33; 95% CI: 0.96, 1.85 for WC categories).

CONCLUSIONS

- MHO phenotype is dynamic and its transition to metabolically unhealthy phenotype or even stable MHO is associated with increased risk of HF. Maintaining metabolic health may provide a clue for preventing HF.

Social determinants of health and heart failure hospitalizations in Brazil

OBJECTIVE

To analyze the relationship between social determinants of health and heart failure hospitalizations in Brazil.

METHOD

A retrospective ecological study, whose units of analysis were the cities of the Brazilian states. The outcome variable was heart failure hospitalization rate. The independent variables were Family Health Strategy coverager, federal transfer to Primary Care, expenditure on Primary Care, overlapping of the female population and age group above 60 years old. Regressive techniques were adopted for panel data, with estimation of weighted least squares by fixed effect.

RESULTS

Twenty-six cities were analyzed. Hospitalization rates showed a non-uniform distribution between the areas, with lower median in the North and higher in the South. The regression model identified a relationship between hospitalization rates and Family Health Strategy coverage, federal transfer to Primary Care, and overlapping of the female population.

CONCLUSION

Heart failure occurrence, a condition sensitive to Primary Care in Brazil, is influenced by social determinants of health represented by demographic, budgetary, and health service coverage factors.