Assessment of Conventional Cardiovascular Risk Factors and Multiple Biomarkers for the Prediction of Incident Heart Failure and Atrial Fibrillation

Abstract Aim Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. Methods and results From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. Conclusion The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

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Abstract P124: Neighborhood Density of Hispanic/Latinos and Left Ventricular Structure: ECHO-SOL and SOL-CASAS

Circulation ◽

10.1161/circ.137.suppl_1.p124 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Sonia Ponce ◽

Matthew A Allison ◽

Jordan A Carlson ◽

Krista M Perreira ◽

Matthew S Loop ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Left Ventricular ◽

Structure And Function ◽

Ethnic Density ◽

Ventricular Structure ◽

Hispanic Latinos ◽

And Function

Introduction: Heart failure represents a significant public health problem because of increasing prevalence and lack of effective medical treatment. Hispanic/Latinos have a high burden of cardio-metabolic comorbidities and adverse socioeconomic conditions that place them at risk for heart failure. However, some literature indicates that among Hispanics/Latinos, residing in areas with high Hispanic/Latino ethnic density is associated with better health outcomes. There is a paucity of data on the effect of Hispanic/Latino ethnic density and risk markers for heart failure. Therefore, we evaluated the association between Hispanic/Latino ethnic concentration and several echocardiographic measures of left ventricular structure and function. Methods: Data on baseline characteristics from the Hispanic Communities Health Study/Study of Latinos (HCHS/SOL), echocardiographic measures of cardiac structure and function (ECHO-SOL), and neighborhood Hispanic/Latino ethnic density (San Diego SOL-CASAS) were analyzed. Hispanic/Latino ethnic density was calculated for each person based on an 800-m buffer around their home. Hispanic/Latino ethnic density was then calculated using data from the 2010 Census as the percent of Hispanic/Latinos divided by the total population at the Census block level and calculating an average value for all Census blocks that overlapped with the participant's address. Multivariable linear regression analysis adjusting for personal demographics and cardiovascular risk factors was conducted. Results: A total of 350 participants with data from all three databases were included in the analysis. The mean age was 55±7 years, 69% were female, and 26%, 38%, and 43% had diabetes, hypertension, and dyslipidemia, respectively. Thirty-six percent had less than high school education, and 58% were low income. In models adjusting for age, sex, education level, income, acculturation, and cardiovascular risk factors, a 1-percent higher Hispanic/Latino ethnic density was associated with lower left ventricular mass (0.47, p-value = 0.02). Other echocardiographic measures of cardiac structure and function were not significantly related to Hispanic/Latino ethnic density. Conclusion: Higher Hispanic/Latino ethnic density was associated with lower LVM independent of personal SES and common cardiovascular risk factors. These findings suggest that Hispanic/Latinos residing in areas with higher Hispanic/Latino ethnic density might have a lower risk of future HF. However, further research to understand the specific factors that mediate the observed associations are necessary.

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Influence of diabetes mellitus interactions with cardiovascular risk factors on post-myocardial infarction heart failure hospitalizations

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.11.086 ◽

2021 ◽

Author(s):

Srikanth Yandrapalli ◽

Aaqib H. Malik ◽

Fnu Namrata ◽

Gayatri Pemmasani ◽

Dhrubajyoti Bandyopadhyay ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Post Myocardial Infarction ◽

Infarction Heart

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Abstract W P121: Stroke Severity in Men and Women: What Proportion of the Disparity Can Be Explained by Differences in Cardiovascular Risk Factors?

Stroke ◽

10.1161/str.45.suppl_1.wp121 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Karen C Albright ◽

Amelia K Boehme ◽

Bisakha Sen ◽

Monica Aswani ◽

Michael T Mullen ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Sex Differences ◽

Cardiovascular Risk ◽

Black Women ◽

Cardiovascular Risk Factors ◽

Stroke Severity ◽

Stroke Subtype ◽

Oaxaca Decomposition ◽

Nihss Score

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.

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P1532Asymptomatic structural heart disease in individuals without apparent cardiovascular risk factors An unnoticed potential precursor stage of heart failure. Results from the STAAB cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0294 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Morbach ◽

G Gelbrich ◽

T Tiffe ◽

F Eichner ◽

M Breunig ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Risk Factor ◽

Cohort Study ◽

Heart Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Structural Heart Disease ◽

Qtc Interval ◽

Lv Ejection Fraction

Abstract Background and aim Prevention of heart failure (HF) relies on early identification and elimination of cardiovascular risk factors. ACC/AHA guidelines define consecutive asymptomatic precursor stages of HF, i.e. stage A (with risk factors for HF), and stage B (asymptomatic cardiac dysfunction). We aimed to identify frequency and characteristics of individuals at risk for HF, i.e. stage A and B, in the general population. Methods The prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study phenotyped a representative sample of 5000 residents (aged 30–79 y) of a medium sized German town, reporting no previous HF diagnosis. Echocardiography was highly quality-controlled. We applied these definitions: HF stage A: ≥1 risk factor for HF (hypertension, arteriosclerotic disease, diabetes mellitus, obesity, metabolic syndrome), but no structural heart disease (SHD); HF stage B: asymptomatic but SHD [reduced left ventricular (LV) ejection fraction, LV hypertrophy, LV dilation, stenosis or grade 2/3 regurgitation of aortic/mitral valve, grade 2/3 diastolic dysfunction], or prior myocardial infarction; Normal (N): no risk factor and no SHD. We focused on subjects in stage B without apparent cardiovascular risk factors qualifying for A (B-not-A) compared to those with risk factors (BA) and N. The first half of the sample (n=2473) served as derivation set (D), the second half (n=2434) as validation set (V). Results We found 42% (D)/45% (V) of subjects in stage A, and 18% (D)/17% (V) in stage B. Among stage B subjects, 31% (D)/29% (V) were B-not-A. Compared to BA, B-not-A subjects were younger [47 vs. 63 y (D)/50 vs 63 years (V); both p<0.001] and more often female [78% vs 56% (D)/79% vs 62% (V); both p<0.001], had higher LV ejection fraction [59% vs 56% (D)/53% vs 48% (V); both p<0.05], lower E/e' [6.7 vs 9.9 (D)/6.9 vs. 9.3 (V); both p<0.001], higher LV volume [64 vs 59 mL/m2 (D)/54 vs 48 mL/m2 (V); both p≤0.01], lower hemoglobin [13.3 vs 13.9 g/dL (D, p=0.02)/13.4 vs 13.8 g/dL (V, p=0.08); both adjusted for sex], and lower QTc interval [423 vs 433 ms (D)/427 vs 438 ms (V); both p≤0.001). Compared to N, subjects in B-not-A were more often female [78% vs 56% (D)/79% vs 61% (V); both p<0.001], had larger QTc interval [423 vs 418 ms (D)/427 vs 420 ms (V); both p<0.05], and more often anemia [11% vs 5% (D, p=0.02)/9% vs 5% (V, p=0.12)]. Conclusions We confirmed, by extensive internal validation, the presence of a hitherto undescribed group of individuals with relevant myocardial alterations, but lacking respective risk factors. Since algorithms in primary prevention do not include echocardiography, this subgroup might be missed. Further investigations should 1) externally validate our finding, 2) study the prognostic course of subjects in group B-not-A, and 3) elaborate the material differences between B-not-A and N to identify potential further novel risk factors for HF. Acknowledgement/Funding German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg (BMBF 01EO1004 and 01EO1504)

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Association of Midlife Cardiovascular Risk Factors With the Risk of Heart Failure Subtypes Later in Life

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.11.008 ◽

2020 ◽

Author(s):

Laura P. Cohen ◽

Eric Vittinghoff ◽

Mark J. Pletcher ◽

Norrina B. Allen ◽

Sanjiv J. Shah ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors

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THE TRADITIONAL CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH INCIDENT LATENT HEART FAILURE IN A GENERAL JAPANESE POPULATION

Journal of Hypertension ◽

10.1097/01.hjh.0000572344.30490.cd ◽

2019 ◽

Vol 37 ◽

pp. e183

Author(s):

Y. Kokubo ◽

M. Watanabe ◽

A. Higashiyama ◽

Y. Nakao ◽

Y. Miyamoto

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Japanese Population ◽

Factors Associated ◽

General Japanese Population

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Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz108 ◽

2019 ◽

Vol 112 (3) ◽

pp. 256-265 ◽

Cited By ~ 6

Author(s):

Yan Chen ◽

Eric J Chow ◽

Kevin C Oeffinger ◽

William L Border ◽

Wendy M Leisenring ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Operating Characteristic ◽

Prediction Models ◽

Characteristic Curve ◽

Childhood Cancer Survivors ◽

Operating Characteristic Curve

Abstract Background Childhood cancer survivors have an increased risk of heart failure, ischemic heart disease, and stroke. They may benefit from prediction models that account for cardiotoxic cancer treatment exposures combined with information on traditional cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes. Methods Childhood Cancer Survivor Study participants (n = 22 643) were followed through age 50 years for incident heart failure, ischemic heart disease, and stroke. Siblings (n = 5056) served as a comparator. Participants were assessed longitudinally for hypertension, dyslipidemia, and diabetes based on self-reported prescription medication use. Half the cohort was used for discovery; the remainder for replication. Models for each outcome were created for survivors ages 20, 25, 30, and 35 years at the time of prediction (n = 12 models). Results For discovery, risk scores based on demographic, cancer treatment, hypertension, dyslipidemia, and diabetes information achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater in 9 and 10 of the 12 models, respectively. For replication, achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater were observed in 7 and 9 of the models, respectively. Across outcomes, the most influential exposures were anthracycline chemotherapy, radiotherapy, diabetes, and hypertension. Survivors were then assigned to statistically distinct risk groups corresponding to cumulative incidences at age 50 years of each target outcome of less than 3% (moderate-risk) or approximately 10% or greater (high-risk). Cumulative incidence of all outcomes was 1% or less among siblings. Conclusions Traditional cardiovascular risk factors remain important for predicting risk of cardiovascular disease among adult-age survivors of childhood cancer. These prediction models provide a framework on which to base future surveillance strategies and interventions.

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