Association of surrogate adiposity markers with prevalence, all-cause mortality and long-term survival of heart failure: a retrospective study from NHANES database

Fan-Shun Guo ^1,2 Chen Guo ^1,2 Jia-Hao Dou ^1,2 Jun-Xiang Wang ³ Rui-Yun Wu ^1,2 Shoufang Song ^1,2 Xue-Lu Sun ^1,2 Yi-Wei Hu ^1,2 Jin Wei ^1,2*

• ¹ Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
• ² Clinical Research Center for Endemic Disease of Shaanxi Province, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
• ³ Medicine Department, Xi'an Jiaotong University, Xi'an, China

Introduction: Obesity, especially abdominal obesity, is more common in patients with heart failure (HF), but body mass index (BMI) cannot accurately describe fat distribution. Several surrogate adiposity markers are available to reflect fat distribution and quantity. The objective of this study was to explore which adiposity marker is most highly correlated with HF prevalence, all-cause mortality and patients’ long-term survival.Methods: The National Health and Nutrition Examination Survey (NHANES) database provided all the data for this study. Logistic regression analyses were adopted to compare the association of each surrogate adiposity marker with the prevalence of HF. Cox proportional hazards models and restricted cubic spline (RCS) analysis were employed to assess the association between surrogate adiposity markers and all-cause mortality in HF patients. The ability of surrogate adiposity markers to predict long-term survival in HF patients was assessed using time-dependent receiver operating characteristic (ROC) curves.Results: 46,257 participants (1,366 HF patients) were encompassed in this retrospective study. An area under the receiver operating characteristic curve (AUC) for the prevalence of HF assessed by weight-adjusted-waist index (WWI) was 0.70 (95% CI: 0.69-0.72). During a median follow-up of 70 months, 700 of 1366 HF patients’ death were recorded. The hazard ratio (HR) for HF patients’ all-cause mortality was 1.33 (95% CI: 1.06-1.66) in the a body shape index (ABSI) quartile 4 group and 1.43 (95% CI: 1.13-1.82) in the WWI quartile 4 group, compared with the lowest quartile group. The AUC for predicting 5-year survival of HF patients using the ABSI was 0.647 (95% CI: 0.61-0.68).Conclusions: WWI is strongly correlated with the prevalence of HF. In HF patients, those with higher WWI and ABSI tend to higher all-cause mortality. ABSI can predict patients’ long-term survival. We recommend the use of WWI and ABSI for assessing obesity in HF patients.