Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study

Yashashwi Pokharel, Wensheng Sun, Salim S. Virani, Vijay Nambi, Ron C. Hoogeveen, Patricia P. Chang, Chiadi E. Ndumele, Scott D. Solomon, Biykem Bozkurt, Elizabeth Selvin, Christie M. Ballantyne, Anita Deswal

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Objectives This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories. Background Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity cardiac troponin T (hs-cTnT) is a sensitive marker of myocardial injury, and predicts incident HF and mortality. Methods Stratifying 1,279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (< and ≥ 14 ng/l), we examined the association of pre-HF body mass index (BMI) with mortality after incident HF hospitalization in the ARIC (Atherosclerosis Risk In Communities) study. Results Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT ≥14 ng/l had higher mortality after incident HF (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.18 to 1.80) compared to individuals with hs-cTnT <14 ng/l in an adjusted model including BMI. Compared with normal weight subjects, the mortality was lower in overweight (HR: 0.69, 95% CI 0.48-0.98) and obese individuals (HR: 0.50; 95% CI: 0.35 to 0.72) with hs-cTnT <14 ng/l; and in those with hs-cTnT ≥14 ng/l (overweight HR: 0.50; 95% CI: 0.30 to 0.83; obese HR: 0.56; 95% CI: 0.34 to 0.91; interaction: p = 0.154 between BMI and hs-cTnT). The lower mortality risk in obese and overweight subjects remained similar when log hs-cTnT was added as a continuous variable to a multivariable model, and in sensitivity analyses after further adjusting for left ventricular hypertrophy or high-sensitivity C-reactive protein. Conclusion Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalJACC: Heart Failure
Issue number1
Publication statusPublished - 1 Jan 2017
Externally publishedYes


  • heart failure
  • myocardial injury
  • obesity paradox
  • outcomes


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