Greater amounts of visceral adipose and lean body mass increase heart failure risk in older women

Objective Clinical body composition measures have not been well-studied in relation to heart failure (HF) risk among older women, which was the objective of this investigation. Methods Participants were 10,521 postmenopausal women without known HF who had whole-body dual energy x-ray absorptiometry scans at baseline (mean age 63), 3- and 6-years later. Total fat and lean mass (kg), abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue area (cm 2 ) were measured. Incident acute decompensated HF hospitalizations were identified annually and adjudicated by trained physicians. A subset of 3,528 women had ejection fraction information available to characterize HF with preserved (HFpEF) and reduced (HFrEF) ejection. Results There were 852 cases of HF, and 116 HFpEF and 107 HFrEF cases during 16.7 (mean) years follow-up. Multivariable hazard ratios (HR) for HF across quartiles (trend, P < .001 all) were VAT 1.00 [ref], 1.16, 1.22, 2.10; SAT 1.00, 1.14, 1.18, 1.62; fat mass 1.00, 1.07, 1.14, 1.67; and lean mass 1.00, 1.02, 1.07, 1.86. HFpEF was associated with VAT (adjusted HR per 1-SD = 1.53; 95% CI: 1.26–1.86), SAT (1.31; 1.08–1.60), fat mass (1.47; 1.21–1.78), and lean mass (1.47; 1.21–1.78). HFrEF was not consistently associated with body composition. Time-varying results over repeated body composition measures were similar as above. Mutually adjusting lean mass and VAT attenuated their associations but each remained significantly positively associated with HF and HFpEF. Conclusions In older women, VAT and lean mass were associated with higher risk of HF and HFpEF. The positive association for lean mass was not fully explained by greater VAT perhaps reflecting poorer lean mass quality with aging.