Associations between combined systemic inflammation and central obesity with heart failure in US adults
Y RazaAbstract
Introduction
Heart failure (HF) prevalence is rising globally. Systemic inflammation and central obesity are recognized risk factors, but their combined association with HF is not well characterised. The waist-to-height ratio (WHtR) better reflects central adiposity than BMI, and high-sensitivity C-reactive protein (hs-CRP) is a marker of systemic inflammation.
Purpose
To examine the independent and joint associations of hs-CRP, WHtR, and a combined hs-CRP×WHtR index with prevalent HF in US adults.
Methods
Data from NHANES 2015-2020 comprising 5,450 adults aged ≥20 years were analyzed. HF was defined via self-report of clinician diagnosis. WHtR was calculated as waist circumference divided by height and standardized (per SD increase). A combined hs-CRP×WHtR variable was generated. Survey-weighted multivariable logistic regression was used to assess associations, adjusting for age, sex, and BMI. Odds ratios (OR) with 95% confidence intervals (CI) were reported.
Results
Both hs-CRP (per 1 mg/L) and WHtR (per SD) were independently associated with HF (hs-CRP: OR 1.017, 95% CI 1.006-1.029, p=0.008; WHtR: OR 2.34, 95% CI 1.10-4.99, p=0.031). The combined hs-CRP×WHtR index showed the strongest association with HF (OR 1.026, 95% CI 1.011-1.042, p=0.004). Age (OR 1.08 per year, 95% CI 1.06-1.11, p<0.001) and male sex (OR 2.38, 95% CI 1.75-3.22, p<0.001) were also significant predictors, whereas BMI was not (OR 0.91, 95% CI 0.82-1.02, p=0.085).
Conclusion
Systemic inflammation and central obesity were independently associated with HF prevalence in US adults, and a combined inflammation–adiposity index showed the strongest association. These findings support integrated assessment of inflammatory and central adiposity phenotypes in HF epidemiology.