Abstract P1084: Association of Body Composition and Incident Heart Failure and Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction in postmenopausal women

Background: As the US population ages, Heart Failure (HF) is reaching epidemic proportions, with heart failure with preserved ejection fraction (HFpEF) placing a particular burden on elderly women. While the association of obesity with the risk of heart failure is well established, the role of visceral adiposity and other measures of body composition have had limited research. Methods: A cohort of 10,527 postmenopausal women, mean age 63.3 (7.4) at baseline had DXA measures of VAT area ( cm 2 ), SAT area (cm 2 ), VAT/SAT ratio, Fat mass(kg), Lean mass (kg), % body fat and BMI (kg/m 2 ) and were followed for 16.7 years with 852 cases of incident HF . A sub-cohort of 3528 women were followed for the same period were evaluated for adjudicated HFpEF and HFrEF with 116 cases of HFpEF and 107 cases of HFrEF. We evaluate the association of the above body composition variables using multiple variable cox proportional hazards models (see tables below) .We also evaluated a comprehensive model including all sociodemographic and lifestyle variables as well as potential confounders/mediators of medical co-morbidities. Results: Both quartile and continuous measures of VAT, SAT, VAT/SAT ratio, Fat mass, lean mass, and BMI were associated with increased risk of HF and HFpEF with stronger associations with HFpEF but not HFrEF in our main model. The comprehensive model including potential mediators showed persistent but diminished associations for VAT, VAT/SAT ratio, Fat mass, Lean mass, and BMI but not SAT or %body fat. Time varying measures of VAT, VAT/SAT ratio showed persistent and stronger associations than baseline measures for HF and HFpEF but not HFrEF. Competing risk models for death and HF subtype when evaluating HFpEF or HFrEF showed similar but slightly attenuated results. Conclusion: Visceral Fat and VAT/SAT ratio, Fat mass, and Lean mass are associated with increased risk of HF and HFpEF but not HFrEF in this cohort of elderly women. Whether new treatments for weight loss that reduce visceral fat will reduce the risk of HF and HFpEF is worthy of future research.