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Prognosis of a malignant phenotype of obesity defined by a cardiac biomarker in hypertension: the Japan Morning Surge-Home Blood Pressure study

Hypertension Research volume 47, pages 487–495 (2024)Cite this article

A Comment to this article was published on 10 January 2024

Abstract

Obesity with increased high-sensitive cardiac troponin T (hs-cTnT) has been reported to be more likely to progress cardiovascular disease (CVD) events, which suggests that hs-cTnT may identify a “malignant” phenotype of obesity. We classified 3513 hypertensive patients from the Japan Morning Surge-Home Blood Pressure (J-HOP) study into groups based on body mass index (BMI) (normal weight: <25 kg/m2, overweight: 25–29.9 kg/m2, obesity: ≥30 kg/m2) and elevations in biomarker levels (hs-cTnT ≥3 ng/mL: 51.3%, 54.9%, 53.3%, and N-terminal pro-brain natriuretic peptide [NT-ProBNP] ≥55 pg/mL: 51.1%, 40.7%, 36.0% in each BMI category). We evaluated the independent and combined associations of BMI and each hs-cTnT/NT-proBNP or both with CVD events (fatal and nonfatal coronary artery disease, stroke, and hospitalized heart failure). During the mean 6.4 ± 3.9-year follow-up, 232 CVD events occurred. Obesity with elevated hs-cTnT was associated with a risk of CVD events compared to normal weight without elevated hs-cTnT (hazard ratio 3.22, 95% confidence interval: 1.83–5.68). A similar pattern of results was also observed across the status of obesity and elevated NT-proBNP. There was a significant interaction between hs-cTnT and CVD events according to the obesity status (p = 0.039), while this association was marginal in NT-proBNP (p = 0.060). The magnitude of the mediation of hs-cTnT for the association between obesity and CVD risk was 41.2%, and that for NT-proBNP was 8.1%. In this Japanese hypertensive population, the elevation of hs-cTnT identified obese patients at particularly high risk for developing CVD events, suggesting that hs-cTnT may identify a ‘malignant’ phenotype of obesity.

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Funding

The 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science, and Technology; a grant from the Foundation for Development of the Community (Tochigi); a grant from Omron Healthcare Co., Ltd.; a Grant-in-Aid for Scientific Research (B) (21390247) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, 2009 to 2013; and funds from the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2011 to 2015, Cooperative Basic and Clinical Research on Circadian Medicine (S1101022) to K. Kario. Funding sponsors had no role in the design or conduct of the study, the collection, management, analysis, or interpretation of the data, the preparation of the article, or the decision to submit the article for publication.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Hiroaki Watanabe, Satoshi Hoshide, Hisoshi Kanegae & Kazuomi Kario

  2. Genki Plaza Medical Center for Health Care, Tokyo, Japan

    Hisoshi Kanegae

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  1. Hiroaki Watanabe
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Correspondence to Kazuomi Kario.

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KK has received research funding from Omron Healthcare Co, Fukuda Denshi, and A&D Co. None of the other authors have any conflicts of interest to disclose.

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Watanabe, H., Hoshide, S., Kanegae, H. et al. Prognosis of a malignant phenotype of obesity defined by a cardiac biomarker in hypertension: the Japan Morning Surge-Home Blood Pressure study. Hypertens Res 47, 487–495 (2024). https://doi.org/10.1038/s41440-023-01468-8

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