Overweight in adolescence portends early heart failure

By Eleanor McDermid

A study of Swedish army conscripts shows that men who have an increased body mass index (BMI) at the age of 18 years risk early heart failure.

And the increased risk began at a BMI generally considered to be healthy, the researchers report in the European Heart Journal. The lowest risk of future heart failure came at a BMI of around 20 kg/m², after which there was a steep increase.

"Although most studies define a normal weight as having a BMI between 18.5 and 25, this is probably not an appropriate definition in the young, most of whom are naturally thin", said lead researcher Annika Rosengren (Sahlgrenska Academy, Gothenburg, Sweden) in a press statement.

"This may be why we see an increase in the risk of heart failure starting at a fairly low BMI level."

Nevertheless, she said it was "surprising" to see such a steep increase starting above a BMI of just 20 kg/m².

The 1,610,437 men in the study were conscripted at an average age of 18.6 years and were followed-up for heart failure hospitalisation for a median of 23.0 years. Heart failure hospitalisation occurred at an average age of 46.6 years.

The incidence of heart failure hospitalisation ranged from 5.47 per 100,000 observation-years for men in the reference BMI category (18.5 to <20 kg/m²) to 39.85 per 100,000 observation-years for those in the highest BMI category (≥35 kg/m²).

There was a significantly increased risk of heart failure hospitalisation even among men within the normal BMI category. After accounting for variables including baseline comorbidities, blood pressure, parental education, and physical fitness, the risk was increased 1.22-fold for men with BMIs from 20.0 to less than 22.5 kg/m² and 1.90-fold for those with BMIs from 22.5 to less than 25.0 kg/m², relative to those in the reference category.

And the relative risk continued to rise with increasing BMI categories to reach a 9.21-fold increased risk for men with a BMI of 35 kg/m² or more. Overall, each 1 kg/m² rise in BMI at the time of conscription conferred a 1.16-fold increase in the risk of later heart failure hospitalisation.

Although the heart failure risk was far greater at the highest BMIs, the researchers stress that "the greatest population burden of heart failure among the young and middle-aged is driven by the high-normal weight or overweight categories because these categories are the most highly represented."

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