Abstract P079: Disparities in Heart Failure in Older Age: Do Individual or Neighbourhood Measures of Deprivation Affect Incidence Over a 10-Year Follow-up?

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Sheena Ramsay ◽  
P H Whincup ◽  
R W Morris ◽  
A.O. Papacosta ◽  
L T Lennon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Older Age ◽  
Neighbourhood Deprivation ◽  
Individual Level ◽  
Cumulative Score ◽  
Neighbourhood Level ◽  
Incident Heart Failure ◽  
Incident Cases

Background: Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and in particular effects of neighbourhood deprivation. The aim of this study was to investigate the association of socioeconomic measures (individual and neighbourhood-level) with incident heart failure in older adults and to examine possible underlying pathways. Methods: A socially and geographically representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Individual-level socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) - a cumulative score of adverse socioeconomic measures from 0 to ≥4 was used. Index of multiple deprivation (IMD) was the small area-level socioeconomic measure (based on income, employment, health, housing, education, access to services and crime) grouped into quintiles of increasing deprivation. Prevalent myocardial infarctions and heart failures were excluded.Results: Among 3839 men, 232 incident cases of heart failure occurred over 10 years. Heart failure risk increased with increasing cumulative score of adverse (individual-level) socioeconomic measures (p for trend=0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95%CI 1.34-3.55) which weakened to 1.99 (95%CI 1.16-3.45), but remained significant after adjusting for neighbourhood deprivation (IMD), systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.78 (95%CI 1.01-3.13). Hazard ratio per IMD quintile (neighbourhood deprivation) was 1.04 (95%CI 0.95-1.14). Conclusions: Disparities in heart failure in older populations need to be addressed - the risk of heart failure in older age was greater in the lowest socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure. This increased risk of heart failure according to individual-level socioeconomic measures was independent of neighbourhood-level deprivation. Neighbourhood level deprivation does not in itself appear to influence risk of heart failure.

Abstract 13944: Biracial Proteomic Profiling Reveals Novel Candidate Pathways in Left Ventricular Hypertrophy and Incident Heart Failure Specific to Black Individuals

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel H Katz ◽  
Usman A Tahir ◽  
Debby Ngo ◽  
Mark Benson ◽  
Yan Gao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Smoking Status ◽  
Left Ventricular ◽  
Proteomic Profiling ◽  
2D Echocardiography ◽  
Heart Study ◽  
Lv Mass ◽  
Leukotriene A4 ◽  
Incident Cases

Background: Increased left ventricular (LV) mass is associated with future adverse cardiovascular events including heart failure (HF). Both increased LV mass and HF disproportionately affect black individuals. To understand the mechanisms that drive disease, particularly in black individuals, we undertook a proteomic screen in a black cohort and compared it to a white cohort. Methods: We measured 1305 plasma proteins using an aptamer-based proteomic platform (SOMAscan™) in 1772 black participants in the Jackson Heart Study (JHS) with available baseline LV mass as assessed by 2D echocardiography, as well as 1600 free of HF with follow-up assessment of incident cases. Mean follow-up time was 11 years; 152 cases of incident HF hospitalization were identified. Models were adjusted for age, sex, body mass index, estimated glomerular filtration rate (as calculated by CKD-EPI equation), systolic blood pressure, hypertension treatment, presence of diabetes, total/HDL cholesterol, prevalent coronary disease, and current smoking status. Incident HF models were also adjusted for incident coronary heart disease. We then compared protein associations in JHS to those observed in whites from the Framingham Heart Study (FHS) to examine significant differences. Results: In JHS, there were 112 proteins associated with LV mass and 10 proteins associated with incident HF hospitalization with FDR <5%. Several proteins showed expected associations with both LV mass and HF, including N-terminal pro-BNP (β = 0.04 [0.02, 0.05], p = 1.0 x 10 -8 , HR = 1.46 [1.20, 1.79], p = 0.0002). The strongest association with LV mass was more novel: leukotriene A4 hydrolase (LKHA4) (β = 0.05 [0.04, 0.06], p = 2.6 x 10 -15 ). Conversely, Fractalkine/CX3CL1 showed a novel association with incident HF (HR = 1.32 [1.14, 1.54], p = 0.0003). While proteins like Cystatin C and N-terminal pro-BNP showed consistent effects in FHS, LKHA4 and Fractalkine were significantly different. Conclusions: We identify several novel biological pathways specific to black individuals hypothesized to contribute to the pathophysiologic cascade of LV hypertrophy and incident HF including LKHA4 and Fractalkine. Further studies are needed to validate these results and elucidate the detailed underlying mechanisms.

scholarly journals Serum Bicarbonate Is Associated with Heart Failure in the Multi-Ethnic Study of Atherosclerosis

2016 ◽  
Vol 45 (2) ◽  
pp. 118-126 ◽  
Author(s):  
Jessica B. Kendrick ◽  
Leila Zelnick ◽  
Michel B. Chonchol ◽  
David Siscovick ◽  
Andrew N. Hoofnagle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Serum Bicarbonate ◽  
Community Based ◽  
Baseline Serum ◽  
Ethnic Study ◽  
Adult Participants ◽  
Kidney Disease Progression ◽  
Incident Heart Failure ◽  
Subclinical Cvd

Background: Low serum bicarbonate concentrations are associated with mortality and kidney disease progression. Data regarding associations between bicarbonate and cardiovascular disease (CVD) are scarce. Methods: We performed a cohort study of 6,229 adult participants from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort free of CVD at baseline. Serum bicarbonate was measured at baseline. Cardiovascular outcomes were defined as: (1) subclinical CVD (left ventricular mass [LVM] and aortic pulse pressure [PP] measured at baseline), (2) incident atherosclerotic cardiovascular events (CVE; composite of myocardial infarction, resuscitated cardiac arrest, stroke, coronary heart disease death, and stroke death), and (3) incident heart failure. Results: During a median (interquartile range) follow-up of 8.5 (7.7-8.6) years, 331 (5.3%) participants had an incident CVE and 174 (2.8%) developed incident heart failure. We stratified analyses by use of diuretics because we observed a significant interaction between diuretic use and bicarbonate with study outcomes. Among diuretic nonusers, with adjustment, bicarbonate ≥25 mEq/L was associated with an estimated 3.0 g greater LVM (95% CI 0.5-5.0) and 1.0 mm Hg higher aortic PP (95% CI 0.4-2.0) compared to bicarbonate 23-24 mEq/L. Each 1 mEq/L of bicarbonate increase was associated with a 13% higher risk of incident heart failure (hazards ratio 1.13, 95% CI 1.01-2.11). Among diuretic users, higher bicarbonate was not associated with CVD. Bicarbonate was not associated with incident atherosclerotic CVE irrespective of diuretic use. Conclusion: Among nonusers of diuretics in a large community-based study, higher serum bicarbonate concentrations are associated with subclinical CVD and new heart failure.

scholarly journals Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Arnaud D. Kaze ◽  
Prasanna Santhanam ◽  
Sebhat Erqou ◽  
Rexford S. Ahima ◽  
Alain Bertoni ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Microvascular Disease ◽  
Hazard Ratio ◽  
Unique Identifier ◽  
Hazard Ratios ◽  
Incident Heart Failure

Background Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus. Methods and Results A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus–related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5‐fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73–3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64–3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51–3.27), 1.30 (95% CI, 0.72–2.36), and 1.33 (95% CI, 0.86–2.07) for nephropathy, retinopathy, and neuropathy, respectively. CONCLUSIONS MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus–related HF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00017953.

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