Background Heart failure (HF) is one of the leading causes of mortality, morbidity and hospitalisation in older adults. Although short stature has been associated with increased risk of coronary heart disease previous studies have consistently shown tall stature to be associated with increased risk of atrial fibrillation (AF) a known major risk factor for the development of HF. Relatively few studies have investigated the association between height and incident HF. We have therefore examined prospectively the association between adult height and incident AF and incident HF in a population based cohort of older men.

Methods Prospective study of 3530 men aged 60–79 years with no diagnosed HF, myocardial infarction or stroke at baseline (1998–2000) followed up for a mean period of 15 years, in which there were 212 incident HF cases. Incident AF was based on a subgroup of men (n=1348) who attended re-examination in 2010–2012. Men were divided into 5 height groups: <168.2, 168.2–172.9, 173.0–176.9, 177.0–183.0 and >183.0 cms based on the quartile distribution of height with the top 5 percent separated out.

Results CVD risk factors tended to decrease with increasing height but a positive association was seen between height and prevalent AF. Tall stature was prospectively associated with increased risk of incident AF. Both short stature (<168.2 cms) and tall stature (>183.0 cms) were associated with significantly increased risk of HF in age-adjusted analysis compared to those in the second height quartile [HR (95% CI) 1.58 (1.07,3.02) and 1.90 (1.04,3.50) respectively]. The increased risk seen in short men was attenuated after adjustment for lifestyle characteristics, established CHD risk factors, inflammation (CRP) and prevalent AF [adjusted HR=1.37 (0.92,2.02) ]. Since tall men had the most favourable CHD risk factors, adjustment increased the risk further (adjusted HR (95% CI) 1.97 (1.05,3.68). However further adjustment for incident AF attenuated the increased risk seen in tall men (HR=1.76 (0.93,3.31)].

Conclusion Both short stature and tall stature are associated with increased HF risk but the pathways underlying these associations are different. The increased risk of HF in short adults appear to be largely explained by adverse CVD risk factors associated with short stature; in tall men the association was partially explained by their increased risk of developing AF. Average body height has increased worldwide over the decades and if this trend continues, the prevalence of tall older adults is likely to increase which may contribute to an increasing burden of AF and HF.