Threshold body mass index and sex-specific waist circumference for increased risk of heart failure with preserved ejection fraction

Duncan J. Campbell, Fei Fei Gong, Michael V. Jelinek, Julian M. Castro, Jennifer M. Coller, Michele McGrady, Umberto Boffa, Louise Shiel, Danny Liew, Simon Stewart, Alice J. Owen, Henry Krum, Christopher M. Reid, David L. Prior

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Background: Body mass indexDeceased. (BMI) is a risk factor for heart failure with preserved ejection fraction (HFpEF). Design: We investigated the threshold BMI and sex-specific waist circumference associated with increased HFpEF incidence in the SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study, a cohort study of a community-based population at increased cardiovascular disease risk. Methods: Inclusion criteria were age ≥60 years with one or more of self-reported hypertension, diabetes, heart disease, abnormal heart rhythm, cerebrovascular disease or renal impairment. Exclusion criteria were known heart failure, ejection fraction <50% or more than mild valve abnormality. Among 3847 SCREEN-HF participants, 73 were diagnosed with HFpEF at a median of 4.5 (interquartile range: 2.9–5.5) years after enrolment. Results: HFpEF incidence rates were higher for BMI ≥27.5 kg/m2 than for BMI < 25 kg/m2, and for waist circumference >100 cm (men) or > 90 cm (women) than for waist circumference ≤94 cm (men) or ≤ 83 cm (women) in Poisson regression analysis. Semiparametric proportional hazards analyses confirmed these BMI and waist circumference thresholds, and exceeding these thresholds was associated with an attributable risk of HFpEF of 44–49%. Conclusions: Both central obesity and overweight were associated with increased HFpEF incidence. Although a randomised trial of weight control would be necessary to establish a causal relationship between obesity/overweight and HFpEF incidence, these data suggest that maintenance of BMI and waist circumference below these thresholds in a community similar to that of the SCREEN-HF cohort may reduce the HFpEF incidence rate by as much as 50%.

Original languageEnglish
Pages (from-to)1594-1602
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number15
Publication statusPublished - Oct 2019


  • body mass index
  • Heart failure with preserved ejection fraction
  • obesity
  • waist circumference

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