Abstract
Ndumele CE, Coresh J, Lazo M, et al.
JACC Heart Fail 2014; 2(6): 600–607.
Obesity is associated with hypertension, diabetes mellitus and the onset of heart failure (HF). The complex relationship between obesity and HF is poorly understood. Obesity is associated with alteration to myocardial contractility and cardiac remodelling.
A total of 9507 subjects enrolled in the Atherosclerosis Risk in Communities study were studied. Patients with severe obesity (n = 1141), defined as body mass index (BMI) > 35 kg/m2, were more likely to have measurable high sensitivity cardiac troponin T (hs-cTnT) than individuals with normal BMI (70% vs. 60%, p < 0.001). The majority was in the range 3–14 ng/L, below the 99th percentile cut-off of 14 ng/L; however, 9% were above 14 ng/L in severely obese subjects. Concentrations >14 ng/L were associated with severe obesity, even after adjusting for traditional risk factors (odds ratio 2.20, 95% CI 1.59 to 3.06). Over 12-year follow up, HF occurred in 869 subjects. Severe obesity and elevated hs-cTnT were associated with a nine-fold higher risk of HF than subjects with normal weight and undetectable hs-cTnT.
This article highlights the serious clinical problem of severe obesity beyond that of associated risk factors. The utilisation of cTnT measurement identifies patients with subclinical cardiac cell damage. This adds further to the use of sensitive cardiac troponins as risk markers rather than a subtle event marker.