The Obesity and Heart Failure Epidemics Among African Americans: Insights From the Jackson Heart Study

•The relationship between obesity and health outcomes such as mortality and heart failure (HF) in African Americans was further explored from the Jackson Heart Study.•Increasing body mass index (BMI) was not associated with increased risk for all-cause mortality in African Americans.•However, increasing BMI was associated with increasing risk for prevalent HF and HF hospitalization in African Americans.•Obesity remains a major public health concern and should be considered as an important risk factor for long-term morbidity in African American populations and a potential target for intervention.

BackgroundHigher rates of obesity and heart failure have been observed in African Americans, but associations with mortality are not well-described. We examined intermediate and long-term clinical implications of obesity in African Americans and associations between obesity and all-cause mortality, heart failure, and heart failure hospitalization.Methods and ResultsWe conducted a retrospective analysis of a community sample of 5292 African Americans participating in the Jackson Heart Study between September 2000 and January 2013. The main outcomes were associations between body mass index (BMI) and all-cause mortality at 9 years and heart failure hospitalization at 7 years using Cox proportional hazards models and interval development of heart failure (median 8 years' follow-up) using a modified Poisson model. At baseline, 1406 (27%) participants were obese and 1416 (27%) were morbidly obese. With increasing BMI, the cumulative incidence of mortality decreased (P = .007), whereas heart failure increased (P < .001). Heart failure hospitalization was more common among morbidly obese participants (9.0%; 95% confidence interval [CI] 7.6-11.7) than among normal-weight patients (6.3%; 95% CI 4.7-8.4). After risk adjustment, BMI was not associated with mortality. Each 1-point increase in BMI was associated with a 5% increase in the risk of heart failure (hazard ratio 1.05; 95% CI 1.03-1.06; P < .001) and the risk of heart failure hospitalization for BMI greater than 32 kg/m2 (hazard ratio 1.05; 95% CI 1.03-1.07; P < .001).ConclusionsObesity and morbid obesity were common in a community sample of African Americans, and both were associated with increased heart failure and heart failure hospitalization.