Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study

Background: 

Comorbidities are associated with an increased risk of incident heart failure (HF). However, comorbidities usually cluster together and data on the association between multimorbidity clusters and incident HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) are lacking. 

Methods: 

We identified multimorbidity patterns in 6839 participants from the prospective observational Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort study using latent class analysis and investigated their association with new-onset HF. 

Results: 

The participants' mean age at baseline was 53.8 years, and 50 % were women. We identified six multimorbidity clusters: 1) young [N = 2118, youngest age and lowest number of chronic conditions], 2) elderly [N = 1198, oldest age, high prevalence of chronic kidney disease and hypercholesterolemia], 3) pulmonary disease [N = 578, high prevalence of respiratory problems], 4) psychosomatic [N = 527, high prevalence of myalgic encephalomyelitis, anxiety and stress], 5) psychological [N = 1815, high prevalence of depression] and 6) obese/physical inactivity [N = 603, high prevalence of obesity, hypertension, myocardial infarction and stroke]. During 110,621 person-years of follow-up 622 participants developed heart failure of which 390 with HFrEF and 220 with HFpEF. After adjusting for potential confounders, the elderly (adjusted hazard ratio (aHR) 2.46, 95 % confidence interval (CI) 1.89–3.20), pulmonary disease (aHR 2.10, 95 % CI 1.51–2.92), and obese/physical inactivity (aHR 3.80, 95 % CI 2.86–5.06) clusters had a higher risk of HF compared with the young cluster, which had the lowest risk. Among all clusters, patients were more likely to develop HFrEF compared to HFpEF. However, the obese/physical inactivity cluster was relatively more likely to develop HFpEF than HFrEF. 

Conclusions: 

Comorbidities naturally clustered in six distinct multimorbidity clusters, each impacting participants' HF risk differently. These data emphasize the importance of addressing multimorbidity as a risk factor for HF.