In a medical records analysis of information gathered on more than 6,000 people, Johns Hopkins Medicine researchers conclude that simply asking older adult patients about their weight history at ages 20 and 40 could provide real value to clinicians in their efforts to predict patients' future risk of heart failure, heart attacks or strokes.
In a report published Nov. 14 in the Journal of the American Heart Association, the investigators say the younger-weight question is potentially a cost-efficient, high-value "ask" likely to help physicians decide how to advise and treat their older patients, particularly now that many people change primary care physicians throughout their lives, and lifelong health records may not transfer.
Asking this simple question about prior lifetime weights provided prognostic information about a person's heart failure risk that was incremental to their measured weights at older ages and other measured traditional heart disease risk factors.
"We've known that the longer a person is obese, the more it becomes problematic by increasing their heart failure risk," says Erin Michos, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine.
"That is why measuring a person's weight at older ages may not tell the whole story about their risk. There's now more evidence that newly obese people are in overall less danger. Our findings emphasize the importance of lifelong maintenance of a healthy weight, as greater cumulative weight from young adulthood is more risky to heart health."
"We already routinely measure weights during a patient's clinic visit to make health recommendations, but we think adding this low-tech question about their prior weight histories can further help direct clinical care," she adds.
"While we acknowledge that self-reported weight history is imperfect, at the very least, asking the question sparks patient reflection and self-motivation to get back to healthier weights from their younger," she added.
Heart attacks, strokes, and other cardiovascular diseases remain the No. 1 killers of Americans. Heart failure, also known as congestive heart failure, is a condition marked by a gradual weakening and stiffening of the heart muscle, diminishing its ability to pump blood.
Physicians routinely attempt to assess risks for heart disease and heart failure as patients age with measures of blood pressure, cholesterol, exercise levels, family history, diet and weight, Michos noted.
Although a single weight measurement in an older adult is helpful, she says, weight history is even more informative, and the new study was in part designed to identify a practical way of getting it that would be considered informative enough to add to clinical care.
For the study, the researchers used data already gathered on 6,437 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) recruited between 2000 and 2002 who were age 45 to 84 at time of enrollment into the study.
Participants have followed an average of 13 years and lived in six U.S. communities: Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; New York City, New York; Los Angeles County, California; and St. Paul, Minnesota.
On average, they were 62 years old at the study's start. Almost 53% of the participants were women. About 39 percent of participants were white, more than 26% were African-American, 22% were Hispanic and a little more than 12% were Chinese-American.
Each participant filled out a survey that reported their weight history at age 20 and 40. Their weights were further tracked during the study period using measurements from a standardized scale over five different in-person visits.
All weights were converted to body mass indexes (BMI) by dividing the weight by the square of height. A BMI less than 25 kilograms per meter squared was considered normal, while a BMI between 25 and 30 was considered overweight, and 30 and above were considered obese.
By the end of all participants' last visit, 290 people had experienced heart failure, and 828 experienced cardiovascular disease events such as heart attacks, stroke and or death as determined by participant and family interviews and patient medical records.
As expected, Michos says, the standard measured weights taken at clinic visits during the 13-year study period were associated with later heart failure risk, with a 34% increased likelihood of heart failure for every 5 kilograms per meters squared increase in BMI, after accounting for other established heart disease risk factors such as age, smoking, physical activity, blood pressure, and diabetes.