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Obesity Linked to Higher Heart Failure Risk in Older Adults With Diabetes

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Obesity Linked to Higher Heart Failure Risk in Older Adults With Diabetes

Obesity increases the risk for heart failure in older adults with diabetes, but not to a significant degree in those without diabetes, according to a new study published in the journal Circulation.

Heart failure — the inability to pump enough blood to meet the body’s needs — is a common form of heart disease in older adults, and is known to especially affect people with diabetes. Recent years have seen a number of new tools and techniques for detecting and treating heart failure, many of which have an outsize benefit for people with diabetes. In 2020, the type 2 diabetes drug Farxiga (dapagliflozin) was approved as a treatment for a common form of heart failure — regardless of whether someone has diabetes — after a clinical trial showed an “overwhelming” benefit for people with the condition. Later study results also showed that taking Farxiga for heart failure may add years of life, and that taking the drug may help people avoid diabetes if they don’t have it already. Another related drug for type 2 diabetes, Jardiance (empagliflozin), was also approved as a treatment for heart failure in 2021 after showing benefits in heart function and quality of life in people with or without diabetes. Also in 2021, researchers developed a new risk score that may help predict the risk for hospitalization due to heart failure in people with type 2 diabetes.

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Various measures of obesity linked to higher heart failure risk

For the latest study, researchers were interested in looking at how three different measures of obesity — body-mass index (BMI, a measure of body weight that takes height into account), waist circumference, and fat mass — were related to the risk for developing heart failure, and how having diabetes affected this risk. The study included 10,387 participants with an average age of 74, of whom 25% had diabetes. None of the participants had heart failure at the beginning of the study. During a follow-up period lasting five years, 447 participants (4%) developed heart failure. Higher levels of each measure of obesity were linked to a higher risk for heart failure overall — for each unit of a statistical measure called a standard deviation, higher BMI increased the risk for heart failure by 19%, higher waist circumference increased it by 27%, and higher fat mass increased it by 17%.

The researchers also saw a significant interaction between participants’ diabetes status and how BMI and waist circumference affected the risk for heart failure. In people with diabetes, each standard deviation of higher BMI increased the risk for heart failure by 29%, higher waist circumference increased it by 48%, and higher fat mass increased it by 25%. But in people with prediabetes or normal glucose levels, there was no significant link between increasing obesity and a higher risk for heart failure. The researchers calculated that among people with diabetes who developed heart failure, 13% of these heart failure cases could be explained by a high BMI, 30% of cases could be explained by a high waist circumference, and 14% of cases could be explained by high fat mass. In contrast, for people without diabetes who developed heart failure, 1% or less of these heart failure cases could be explained by any measure of obesity.

The researchers concluded that obesity-related measures are particularly linked to heart failure in people with diabetes — suggesting that efforts to combat obesity may lead to greater cardiovascular benefits for people with diabetes than for people without diabetes.

Want to learn more about weight management? Read “Tried and True Weight-Loss Techniques,” “Losing Weight Without Feeling Hungry: Eight Tips,” and “Seven Ways to Lose Weight.”

Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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