Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study.

OBJECTIVES: This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories.

BACKGROUND: Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity cardiac troponin T (hs-cTnT) is a sensitive marker of myocardial injury, and predicts incident HF and mortality.

METHODS: Stratifying 1,279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (

RESULTS: Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT ≥14 ng/l had higher mortality after incident HF (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.18 to 1.80) compared to individuals with hs-cTnT 

CONCLUSION: Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury. (Atherosclerosis Risk In Communities [ARIC]; NCT00005131).