{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:06:59Z","timestamp":1790564819509,"version":"4.1.0"},"reference-count":47,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["818715"],"award-info":[{"award-number":["818715"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002996","name":"Netherlands Heart Foundation","doi-asserted-by":"publisher","award":["2020B005"],"award-info":[{"award-number":["2020B005"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002996","name":"Netherlands Heart Foundation","doi-asserted-by":"publisher","award":["01-003-2022-0358"],"award-info":[{"award-number":["01-003-2022-0358"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002997","name":"Kidney Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002997","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","internationaljournalofcardiology.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Cardiology"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.ijcard.2025.133914","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T21:00:10Z","timestamp":1758574810000},"page":"133914","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"special_numbering":"C","title":["Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study"],"prefix":"10.1016","volume":"442","author":[{"given":"Bart J.","family":"van Essen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie Ang En","family":"Dan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganash N.","family":"Tharsana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palvinder","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.E.","family":"Emmens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Ouwerkerk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron T.","family":"Gansevoort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan J.L.","family":"Bakker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf A.","family":"de Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Damman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"van Veldhuisen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan A.","family":"Voors","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper","family":"Tromp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ijcard.2025.133914_bb0005","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/eurpub\/cky098","article-title":"Defining and measuring multimorbidity: a systematic review of systematic reviews","volume":"29","author":"Johnston","year":"2019","journal-title":"Eur. J. Pub. Health"},{"key":"10.1016\/j.ijcard.2025.133914_bb0010","article-title":"Comorbidity versus multimorbidity: why it matters","volume":"11","author":"Harrison","year":"2021","journal-title":"J. Comorb."},{"key":"10.1016\/j.ijcard.2025.133914_bb0015","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12916-020-1508-1","article-title":"High-risk multimorbidity patterns on the road to cardiovascular mortality","volume":"18","author":"Haug","year":"2020","journal-title":"BMC Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0020","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3109\/13814789609162146","article-title":"Comorbidity or multimorbidity: what\u2019s in a name? A review of literature","volume":"2","author":"van den Akker","year":"1996","journal-title":"Eur. J. Gen. Pract."},{"key":"10.1016\/j.ijcard.2025.133914_bb0025","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/eurheartj\/eht066","article-title":"Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND","volume":"34","author":"Brouwers","year":"2013","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0030","article-title":"Multimorbidity in patients with heart failure from 11 Asian regions: a prospective cohort study using the ASIAN-HF registry","volume":"15","author":"Tromp","year":"2018","journal-title":"PLoS Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0035","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1016\/0735-1097(93)90455-A","article-title":"The epidemiology of heart failure: the Framingham study","volume":"22","author":"Ho","year":"1993","journal-title":"J. Am. Coll. Cardiol."},{"key":"10.1016\/j.ijcard.2025.133914_bb0040","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1161\/CIRCULATIONAHA.109.929661","article-title":"Multimarker approach for the prediction of heart failure incidence in the community","volume":"122","author":"Velagaleti","year":"2010","journal-title":"Circulation"},{"key":"10.1016\/j.ijcard.2025.133914_bb0045","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S1388-9842(00)00141-0","article-title":"More \u2018malignant\u2019 than cancer? Five-year survival following a first admission for heart failure","volume":"3","author":"Stewart","year":"2001","journal-title":"Eur. J. Heart Fail."},{"key":"10.1016\/j.ijcard.2025.133914_bb0050","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat. Rev. Dis. Primers"},{"key":"10.1016\/j.ijcard.2025.133914_bb0055","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002516","article-title":"Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: a 20-year cohort study","volume":"15","author":"Xu","year":"2018","journal-title":"PLoS Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0060","first-page":"9","article-title":"Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting","author":"Ashworth","year":"2019","journal-title":"BMJ Open"},{"key":"10.1016\/j.ijcard.2025.133914_bb0065","doi-asserted-by":"crossref","first-page":"5134","DOI":"10.1038\/s41598-022-08690-3","article-title":"Identifying multimorbidity clusters in an unselected population of hospitalised patients","volume":"12","author":"Robertson","year":"2022","journal-title":"Sci. Rep."},{"key":"10.1016\/j.ijcard.2025.133914_bb0070","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033174","article-title":"Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records","volume":"9","author":"Gimeno-Miguel","year":"2019","journal-title":"BMJ Open"},{"key":"10.1016\/j.ijcard.2025.133914_bb0075","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002545","article-title":"Cardiovascular disease and multimorbidity: a call for interdisciplinary research and personalized cardiovascular care","volume":"15","author":"Rahimi","year":"2018","journal-title":"PLoS Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0080","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.amjmed.2014.08.024","article-title":"Multimorbidity in heart failure: a community perspective","volume":"128","author":"Chamberlain","year":"2015","journal-title":"Am. J. Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0085","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1053\/euhj.2000.2248","article-title":"Microalbuminuria is independently associated with ischaemic electrocardiographic abnormalities in a large non-diabetic population. The PREVEND (prevention of REnal and vascular ENdstage disease) study","volume":"21","author":"Diercks","year":"2000","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0090","doi-asserted-by":"crossref","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"ESC guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McCarthy","year":"2024","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0095","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0100","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1002\/clc.23729","article-title":"Proenkephalin and the risk of new-onset heart failure: data from prevention of renal and vascular end-stage disease","volume":"44","author":"Emmens","year":"2021","journal-title":"Clin. Cardiol."},{"key":"10.1016\/j.ijcard.2025.133914_bb0105","author":"Statistics Netherlands"},{"key":"10.1016\/j.ijcard.2025.133914_bb0110","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1093\/eurheartj\/ehae868","article-title":"Sex-specific risk factors for new-onset heart failure: the PREVEND study at 25 years","volume":"46","author":"Van","year":"2025","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0115","doi-asserted-by":"crossref","first-page":"440","DOI":"10.3758\/s13428-018-1188-3","article-title":"Value of sample size for computation of the Bayesian information criterion (BIC) in multilevel modeling","volume":"51","author":"Lorah","year":"2019","journal-title":"Behav. Res. Methods"},{"key":"10.1016\/j.ijcard.2025.133914_bb0120","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/s12877-017-0586-1","article-title":"Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study","volume":"17","author":"Olaya","year":"2017","journal-title":"BMC Geriatr."},{"key":"10.1016\/j.ijcard.2025.133914_bb0125","article-title":"Identifying longitudinal clusters of multimorbidity in an urban setting: a population-based cross-sectional study","volume":"3","author":"Bisquera","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"10.1016\/j.ijcard.2025.133914_bb0130","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245053","article-title":"Multimorbidity patterns and their relationship to mortality in the US older adult population","volume":"16","author":"Zheng","year":"2021","journal-title":"PLoS One"},{"key":"10.1016\/j.ijcard.2025.133914_bb0135","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1093\/gerona\/gly205","article-title":"Multimorbidity patterns, frailty, and survival in community-dwelling older adults","volume":"74","author":"Nguyen","year":"2019","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"10.1016\/j.ijcard.2025.133914_bb0140","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1186\/s12877-022-03154-9","article-title":"Multimorbidity patterns and associated factors in older Chinese: results from the China health and retirement longitudinal study","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Geriatr."},{"key":"10.1016\/j.ijcard.2025.133914_bb0145","doi-asserted-by":"crossref","DOI":"10.1016\/j.archger.2023.105067","article-title":"Multimorbidity patterns in the German general population aged 40 years and over","volume":"114","author":"Amirzada","year":"2023","journal-title":"Arch. Gerontol. Geriatr."},{"key":"10.1016\/j.ijcard.2025.133914_bb0150","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12916-020-01543-8","article-title":"Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study","volume":"18","author":"Zhu","year":"2020","journal-title":"BMC Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0155","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034441","article-title":"Multimorbidity patterns in low-middle and high income regions: a multiregion latent class analysis using ATHLOS harmonised cohorts","volume":"10","author":"Bayes-Marin","year":"2020","journal-title":"BMJ Open"},{"key":"10.1016\/j.ijcard.2025.133914_bb0160","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1186\/s12889-021-11706-8","article-title":"Comparisons of disease cluster patterns, prevalence and health factors in the USA, Canada, England and Ireland","volume":"21","author":"Hern\u00e1ndez","year":"2021","journal-title":"BMC Public Health"},{"key":"10.1016\/j.ijcard.2025.133914_bb0165","doi-asserted-by":"crossref","DOI":"10.1177\/26335565241247430","article-title":"Assigning disease clusters to people: a cohort study of the implications for understanding health outcomes in people with multiple long-term conditions","volume":"14","author":"Beaney","year":"2024","journal-title":"J. Multimorb. Comorb."},{"key":"10.1016\/j.ijcard.2025.133914_bb0170","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0294666","article-title":"Clustering long-term health conditions among 67728 people with multimorbidity using electronic health records in Scotland","volume":"18","author":"Fagbamigbe","year":"2023","journal-title":"PLoS One"},{"key":"10.1016\/j.ijcard.2025.133914_bb0175","doi-asserted-by":"crossref","first-page":"3034","DOI":"10.1038\/s41598-020-59668-y","article-title":"The patterns of non-communicable disease multimorbidity in Iran: a multilevel analysis","volume":"10","author":"Khorrami","year":"2020","journal-title":"Sci. Rep."},{"key":"10.1016\/j.ijcard.2025.133914_bb0180","doi-asserted-by":"crossref","DOI":"10.1016\/j.archger.2023.104959","article-title":"Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China","volume":"109","author":"Zhao","year":"2023","journal-title":"Arch. Gerontol. Geriatr."},{"key":"10.1016\/j.ijcard.2025.133914_bb0185","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/j.jacc.2014.07.979","article-title":"Clinical implications of chronic heart failure phenotypes defined by cluster analysis","volume":"64","author":"Ahmad","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"10.1016\/j.ijcard.2025.133914_bb0190","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12916-020-01881-7","article-title":"Model-based comorbidity clusters in patients with heart failure: association with clinical outcomes and healthcare utilization","volume":"19","author":"Gulea","year":"2021","journal-title":"BMC Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0195","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.jchf.2018.09.006","article-title":"Physical activity, fitness, and obesity in heart failure with preserved ejection fraction","volume":"6","author":"Pandey","year":"2018","journal-title":"JACC Heart Fail"},{"key":"10.1016\/j.ijcard.2025.133914_bb0200","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jchf.2018.05.018","article-title":"The Association of Obesity and Cardiometabolic Traits with Incident HFpEF and HFrEF","volume":"6","author":"Savji","year":"2018","journal-title":"JACC Heart Fail"},{"key":"10.1016\/j.ijcard.2025.133914_bb0205","doi-asserted-by":"crossref","DOI":"10.1016\/j.diabres.2020.108436","article-title":"Impaired fasting plasma glucose is a risk indicator of interventricular septum thickening among non-diabetic subjects with obesity","volume":"169","author":"Zupo","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"10.1016\/j.ijcard.2025.133914_bb0210","doi-asserted-by":"crossref","first-page":"ii221","DOI":"10.1093\/eurheartjsupp\/suae031","article-title":"Italian Association of Hospital Cardiologists position paper\u2014obesity in adults: a clinical primer","volume":"26","author":"Angela Di Fusco","year":"2024","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0215","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S2213-8587(21)00203-5","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials","volume":"9","author":"Sattar","year":"2021","journal-title":"Lancet Diabetes Endocrinol."},{"key":"10.1016\/j.ijcard.2025.133914_bb0220","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1038\/s41591-024-03052-0","article-title":"Effectiveness of bariatric metabolic surgery versus glucagon-like peptide-1 receptor agonists for prevention of congestive heart failure","volume":"30","author":"Wolff Sagy","year":"2024","journal-title":"Nat. Med."},{"key":"10.1016\/j.ijcard.2025.133914_bb0225","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1161\/CIRCULATIONAHA.116.025629","article-title":"Weight loss and heart failure: a Nationwide study of gastric bypass surgery versus intensive lifestyle treatment","volume":"135","author":"Sundstr\u00f6m","year":"2017","journal-title":"Circulation"},{"key":"10.1016\/j.ijcard.2025.133914_bb0230","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1093\/eurheartj\/ehz295","article-title":"Surgical obesity treatment and the risk of heart failure","volume":"40","author":"Jamaly","year":"2019","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2025.133914_bb0235","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1056\/NEJMoa2306963","article-title":"Semaglutide in patients with heart failure with preserved ejection fraction and obesity","volume":"389","author":"Kosiborod","year":"2023","journal-title":"N. Engl. J. Med."}],"container-title":["International Journal of Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016752732500957X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016752732500957X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T16:31:24Z","timestamp":1780763484000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S016752732500957X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":47,"alternative-id":["S016752732500957X"],"URL":"https:\/\/doi.org\/10.1016\/j.ijcard.2025.133914","relation":{},"ISSN":["0167-5273"],"issn-type":[{"value":"0167-5273","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study","name":"articletitle","label":"Article Title"},{"value":"International Journal of Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ijcard.2025.133914","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"133914"}}