Why the study?
The extent to which body mass index and waist-to-height ratio contribute to the risk of early-onset heart failure in adults under 45 years remains unclear.
Do extreme BMI and elevated WHtR increase the risk of incident early-onset heart failure in adults under 45?
Do extreme BMI and elevated WHtR increase the risk of incident early-onset heart failure in adults under 45?
Extreme BMI (underweight and class III obesity) and high waist-to-height ratio are associated with an increased risk of early-onset heart failure, particularly HFpEF, in young adults.
Early-onset heart failure (HF) is an emerging public health concern associated with substantial morbidity and mortality in adults under 45 years. The extent to which body mass index (BMI) and waist-to-height ratio (WHtR) contribute to the risk of early-onset heart failure remains unclear. We analyzed data from 88,931 participants aged 18–44 years in the All of Us cohort with baseline BMI or WHtR data and linked electronic health records, excluding those with prior HF, cardiomyopathy, or malignancy. BMI was categorized into underweight, normal weight, overweight, and class I–III obesity. High WHtR was defined as WHtR≥0.5 . Incident HF and subtypes (HFrEF and HFpEF) were identified. Cox proportional hazards models estimated hazard ratios (HRs), and C-index statistics assessed the added discriminative value of BMI and WHtR. In this study population, the mean age was 32.0 years (SD: 7.2). 65.4% were females and 21.0% were Black. Over a median 3.0-year follow-up, 507 participants developed HF. After mutual adjustment and accounting for demographic and clinical factors, extreme BMI and elevated WHtR were associated with incident HF. Specifically, the hazard ratios were 2.9 (95% CI: 1.3–6.3) for underweight, 1.8 (95% CI: 1.1–2.9) for class III obesity, and 1.8 (95% CI: 1.1–2.8) for WHtR≥0.5. These associations were observed for HFpEF but not for HFrEF. Adding WHtR to BMI modestly improved risk discrimination, suggesting incremental value beyond BMI alone for risk stratification (C-index: 0.790 vs. 0.783 for HF, and 0.880 vs. 0.873 for HFpEF). Extreme BMI, including both underweight and class III obesity, as well as high WHtR, were associated with increased risk of early-onset HF, especially HFpEF, in young adults. WHtR adds incremental values to the BMI regarding short-term HF risk. These findings may inform risk stratification approaches for early-onset HF.
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Yao et al. (2026) studied this question.
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