Eli Lilly and Company Indianapolis, Indiana, United States
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous clinical syndrome resulting from various pathophysiological processes. Coexisting obesity-HFpEF displays a distinct phenotype where increased visceral adiposity plays a causal role. The epidemiology of this phenotype is not well characterized in the literature.
Objectives: To describe the incidence and prevalence of coexisting obesity-HFpEF among adult population in the United States.
Methods: Administrative claims data for adults (≥18 years old) enrolled in the IBM MarketScan database between August 2017 and August 2019 were analyzed. Obesity and HFpEF were defined by ICD-9/10-CM diagnosis codes at inpatient and outpatient settings. Period prevalence rate per 100 people and cumulative incidence rate per 100 person-years of coexisting obesity-HFpEF were calculated. Rates were stratified by age and sex. The prevalence of selected comorbidities among adults with coexisting obesity-HFpEF was estimated and compared to general population without obesity and HFpEF.
Results: During the study period, >36 million adults were eligible for analysis (Mean±SD age 42.4±16.6 years, 54.4% females). The incidence and prevalence rates of coexisting obesity-HFpEF were 0.06 per 100 person-years and 0.2 per 100 persons, respectively. The corresponding rates appear to increase with age: 18-44 years, 0.01 and 0.03; 45-54 years, 0.05 and 0.2; 55-64 years, 0.11 and 0.4; 65-74 years, 0.28 and 1.0; and ≥75 years, 0.39 and 1.3. There is no difference in the prevalence of coexisting obesity-HFpEF between men and women (0.2 per 100 persons); however, women have higher incidence rate than men (0.07 versus 0.06 per 100 person-years). Adults with coexisting obesity-HFpEF have higher prevalence of comorbidities compared to general population without obesity-HFpEF: approximately 71% have type 2 diabetes (versus 28%); 96% have hypertension (versus 57%); 85% have hyperlipidemia (versus 54%); 47% have non-fatal major adverse cardiovascular events, e.g. myocardial infarction, stroke, and angina (versus 9%); 49% have chronic kidney disease (versus 6.2%); and 9.3% have nonalcoholic fatty liver disease and steatohepatitis (versus 4.1%).
Conclusions: While concurrent HFpEF and obesity is an uncommon phenotype of heart failure, the complications and comorbidities associated with it are common.
