Obesity Epidemic among Late Teens May Presage Heart Failure Crisis, Study Suggests

By Thomas Crocker
Sunday, January 1, 2017

Research finds that young men in the middle- to high-normal range of BMI have elevated risk for heart failure when they reach middle age — earlier than heart failure typically develops.

Approximately 5.7 million Americans are living with heart failure, according to the CDC. The typical profile of a heart failure patient is a man age 65 or older, according to the National Institutes of Health, and patients usually have comorbidities, such as coronary artery disease, hypertension and diabetes. Recent research from Sweden indicates the prevalence of obesity in the young, however, could lead to more diagnoses of heart failure in midlife in the future.

The Obesity Effect

Annika Rosengren, MD, PhD, FESC, Professor of Medicine at Sahlgrenska University Hospital in Gothenburg, Sweden; Maria Åberg, MD, Assistant Professor in the Department of Public Health and Community Medicine at the University of Gothenburg’s Institute of Medicine; and colleagues followed more than 1.6 million men in the Swedish Conscript registry who were drafted at age 18 between 1968 and 2005. They tracked the men for an average of 23 years. Approximately 5,500 were admitted to a hospital for heart failure during the follow-up period at an average age of about 47. Nearly 80 percent of the men in the study had had a normal BMI when they entered military service.

However, the researchers found that the men’s heart failure risk began to rise even while they were well within the normal range of 18.5 to 25. Heart failure risk increased 16 percent for every unit of BMI, beginning with a BMI of 20. Individuals with a BMI of 20 to 22.5 at age 18 were 22 percent more likely to develop heart failure than individuals with a BMI between 18.5 and 20. Those in the next highest BMI range, 22.5 to 25, were nearly twice as vulnerable to heart failure. Men with a BMI of 35 or more were 10 times more likely to have heart failure later in life than their non-obese peers.

“Obesity is a well-known risk factor for heart failure, and our own [previous] work has shown an increase in risk in middle-aged men starting in the high-normal range of 22.5 to 25 BMI,” Dr. Rosengren says. “However, [that] was a much smaller study, and very few of those men who were investigated in the early 1970s had a BMI of 35 or higher. So the [current study’s] finding of an increase in men in the normal BMI range did not surprise me; that has been found in other middle-aged populations, as well. What did [surprise me] was the very high risk among the young men with obesity, where the risk increase was much steeper than in our study of middle-aged men.”

What could account for the finding that young men on the middle or high range of normal BMI have a greater risk for heart failure?

“Probably a slightly increased early adult BMI is a marker that predicts dietary habits later in life as a potential link to midlife cardiometabolic risk profile,” Dr. Åberg says. “[E]ven slight obesity has health risks, and the risk of disease is present already in comparatively young ages.”

Troubling Vision of the Future

Solving the obesity crisis and reducing or avoiding its potential consequences, including early heart failure, will take massive effort on a societal scale. Understanding the seriousness of those implications, Dr. Rosengren believes, is a first step. Still, much must be done to alter the present trajectory of obesity rates.

“If current trends continue, the probability of halting the epidemic is virtually zero,” Dr. Rosengren says. “As the population of obese and very obese young people grows older, we may be looking at a totally new scenario and disease pattern within the next few decades.”

For Dr. Åberg, the study’s findings are a call to action.

“We have a huge challenge in the coming years to prevent obesity in children and young people through the education of healthcare professionals, students, parents and teachers,” she says. “We need early identification of young people at risk. We need to find methods and interventions to reduce obesity among children and adolescents that are more rapid and longer-lasting than today’s. We also have to find better combinations of changing diet and physical activity, probably with different programs for different types of personalities.”