Abstract P168: The Association of Longitudinal Changes in Metabolic Syndrome With Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Tolulope A Adesiyun ◽  
Lucia Kwak ◽  
Kavita Sharma ◽  
Vijay Nambi ◽  
Erin D Michos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Metabolic Syndrome ◽  
Cox Regression ◽  
Positive Association ◽  
Atherosclerosis Risk In Communities ◽  
Low Hdl ◽  
Using Data ◽  
Aric Study ◽  
Number Of Individuals ◽  
Over Time

Background: Metabolic syndrome (MS) is a risk factor for the development of heart failure (HF). However, little is known about how changes in MS over time are associated with HF risk. Hypothesis: We hypothesized that increasing MS components over time and a longer duration of MS would be associated with greater HF risk. Methods: We studied 8,104 participants at ARIC Visit 4 (1996-98) without baseline HF, coronary heart disease or diabetes. MS components were defined using AHA/NHLBI criteria for waist circumference, hyperglycemia, elevated blood pressure, low HDL-C and hypertriglyceridemia, and MS was diagnosed if ≥ 3 criteria were present. Using data on MS components from Visit 1 (1987-89) through 4, we used multivariate Cox regression models to evaluate associations of changes in MS components over time and duration of MS with incident HF occurring after Visit 4. Results: The mean age was 63 years (+/-6), with 58% female. Over a median follow-up of 16 years, there were 902 HF events. Compared to those without MS at Visits 1 and 4, those with MS at both time points had a hazard ratio (HR) for HF of 1.87 (95% CI 1.60-2.19), while those with no MS at Visit 1 but MS at Visit 4 (HR 1.38; 95% CI 1.16-1.64) and those with MS at Visit 1 but not at Visit 4 (1.51; 95% CI 1.13-2.00) had more modest risk associations. Among those without MS at Visit 1, those with 0 MS components at both Visits 1 and 4 had lowest HF risk (reference), with progressively higher risk seen for those who increased to 1-2 (HR 1.66; 95% CI 1.06-2.61), 3 (HR 2.15; 95% CI 1.37-3.38) and 4-5 (HR 2.55; 95% CI 1.58-4.13) MS components by Visit 4. Duration of MS had a positive association with HF risk (Figure), with a HR of 1.08 (95% CI 1.06-1.10) per year of MS duration. Conclusions: Progression in MS components over time and a longer duration of MS are associated with increased HF risk. Given the cardiovascular implications of these findings, particularly for the growing number of individuals developing MS components at an early age, strategies to prevent MS onset and progression should be implemented widely.

Abstract 17187: The Association of Longitudinal Patterns of Metabolic Syndrome With Elevated hs-cTnT: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Rachit M Vakil ◽  
Tolulope Adesiyun ◽  
Lucia Kwak ◽  
Kavita Sharma ◽  
Vijay Nambi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Myocardial Injury ◽  
Troponin T ◽  
High Sensitivity ◽  
Atherosclerosis Risk In Communities ◽  
Logistic Regression Models ◽  
High Waist Circumference ◽  
Low Hdl ◽  
Using Data ◽  
Over Time

Background: Longitudinal increases in metabolic syndrome (MS) components are associated with increased heart failure (HF) risk, but the association of MS change over time with subclinical myocardial injury is unknown. Hypothesis: Greater progression and duration of MS is associated with subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin T (hs-cTnT). Methods: We studied 8,170 participants (mean age 63, 59% female) without coronary heart disease, HF or diabetes at ARIC Visit 4 (1996-1998) with available data on MS components from the first four ARIC visits and hs-cTnT data at Visit 4. We defined MS using AHA/NHLBI criteria for high waist circumference (WC), hyperglycemia, elevated blood pressure (BP), low HDL-C and hypertriglyceridemia, with a diagnosis of MS made by ≥ 3 components. Using data on MS components from Visit 1 (1987-89) through 4, we used logistic regression models adjusted for demographics and cardiovascular risk factors to evaluate associations of changes in MS components over time and duration of MS with elevated hs-cTnT (≥ 14 ng/L) at Visit 4. Results: 3,644 (45%) of Visit 4 participants had MS. Greater number of MS components at Visit 4 was associated with a higher likelihood of elevated hs-cTnT, with the highest odds seen for those with 5 MS components (OR 2.32; 95%CI: 1.39-3.87) compared to those with none. Among MS components, the strongest associations were seen for elevated BP and high WC. Among participants without MS at V1, those with no MS components at both Visits 1 and 4 had the lowest odds of elevated hs-cTnT (reference), with progressively higher likelihood of elevated hs-cTnT for those increasing to 1-2 (OR 1.12; 95%CI 0.61-2.06), 3 (OR 1.90; 95%CI 1.04-3.45) and 4-5 (OR 2.64; 95%CI 1.41-4.92) MS components by Visit 4. MS duration was also significantly associated with elevated hs-cTnT, with an OR of 1.08 (95%CI: 1.06-1.11) per year of MS duration. Conclusions: Greater MS severity and progression, and longer duration of MS, are associated with a higher likelihood of subclinical myocardial injury. This may have mechanistic implications for the association between MS and HF, and underscores the need to refine strategies to prevent MS onset and progression.

Abstract P086: Metabolic Risk, Galectin-3 And Heart Failure: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Justin B Echouffo Tcheugui ◽  
Sui Zhang ◽  
Roberta Florido ◽  
Erin Michos ◽  
VIJAY NAMBI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Risk Group ◽  
Metabolic Risk ◽  
Prognostic Information ◽  
Cross Sectional ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Galectin 3 ◽  
Aric Study

Introduction: Diabetes and metabolic syndrome (MetS) confer an increased risk of heart failure (HF) through poorly understood mechanisms. Galectin-3 (Gal-3) is a marker of fibrosis linked to greater HF risk. The inter-relationships among diabetes, MetS and Gal-3, and related implications for HF risk, are not well understood. Hypothesis: Diabetes and MetS are associated with elevated Gal-3, and high Gal-3 indicates greater HF risk among those with diabetes or MetS. Methods: We included 8,445 participants (mean age 63, 59% male, 21% Black) at ARIC Visit 4 (1996-1999) without baseline HF. We categorized participants by metabolic risk (no diabetes/no MetS; MetS only; diabetes with or without MetS), and Gal-3 levels (gender-specific quartiles). We assessed the associations of metabolic risk categories with high Gal-3 (≥75 th percentile) using logistic regression. We used Cox regression to evaluate associations of cross-categories of metabolic risk group and Gal-3 quartiles with incident HF. Results: In cross-sectional analyses, those with MetS were more likely to have elevated Gal-3 levels than those with no diabetes or MetS (OR 1.29, 95%CI 1.13-1.47). The additional presence of diabetes did not change the likelihood of elevated Gal-3 (OR 1.29, 95%CI 1.08-1.55). Over 20.5 years of follow-up, there were 1,611 HF events. Higher Gal-3 was associated with higher HF risk in each metabolic risk group, and higher metabolic risk group was associated with greater HF risk in each Gal-3 quartile. There was no interaction between Gal-3 and metabolic risk group on HF risk ( P =0.15). The combination of diabetes &MetS and high Gal-3 was associated with an almost 5-fold higher risk of incident HF (HR 4.93; 95% CI: 3.77 - 6.44) than the combination of no diabetes/MetS and low Gal-3 (first quartile) ( Table ). Conclusions: MetS was associated with higher levels of Gal-3. Metabolic risk group and Gal-3 provided powerful complementary prognostic information regarding HF risk. Fibrosis likely plays a role in the development of HF linked to metabolic risk.

Abstract P055: Diabetes, Early Heart Failures Stages (A & B), And Progression To Overt Heart Failure In Older Adults: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Justin B Echouffo Tcheugui ◽  
Chiadi E Ndumele ◽  
Sui Zhang ◽  
Roberta Florido ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Glycemic Control ◽  
Cox Regression ◽  
Absolute Risk ◽  
Atherosclerosis Risk In Communities ◽  
Uncontrolled Diabetes ◽  
Clinical Benefits ◽  
Diagnosed Diabetes ◽  
Aric Study

Introduction: Diabetes confers a high risk of heart failure (HF). However, the influence of diabetes in preclinical HF (stages A or B) on the progression to overt HF is not well understood. Hypothesis: Diabetes accelerates progression to clinically overt HF, but significantly more so in stage A than B. Methods: We included older adults (aged 66-90 years) without clinical HF (n= 4782) who attended ARIC study visit 5 (2011-2013). We categorized participants into stage A (n=3067) or B (n=1715) HF. Within each stage A or B, we used Cox regression to quantify the associations of diagnosed diabetes and glycemic control (HbA 1C <7% vs. ≥ 7%) with progression to HF. We also evaluated the relative and absolute risk associations of cross-categories of HF stages (A vs. B) and diabetes and glycemic control with incident HF. Results: There were 401 HF events during a median 6.3 years follow-up (mean age 75, 59% female, 21% Black, 28% with diabetes). The 7.6-year cumulative HF risk among individuals with diabetes and HbA 1C ≥ 7% vs. those without diabetes was 11.9% vs. 4.5% in stage A, and 18.1% vs. 13.6% in stage B. In stages A and B, individuals with uncontrolled diabetes had significantly higher risks of HF compared to those without diabetes (all P <0.05; Table ). Uncontrolled diabetes was more strongly associated with HF in stage A than stage B ( P =0.02). In cross-categories of HF stage, diabetes, and glycemic control, individuals with stage B HF and uncontrolled diabetes had greater than 4-fold risk of HF than those with stage A HF without diabetes. Conclusions: Among older adults with preclinical HF stages (A and B), uncontrolled diabetes is associated with substantial short-term (~8 year) risk of HF and should be a focus of aggressive preventive therapies. Newer anti-diabetes therapies such as SGLT2 inhibitors are currently recommended in adults with diabetes and clinical HF, but not stages A and B. Our results suggest that among older adults, such therapies may yield clinical benefits in early HF stages.

Abstract 14482: Apparent Resistant Hypertension is a Marker of Risk: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Magnus O Wijkman ◽  
Marcus Malachias ◽  
Brian Claggett ◽  
Susan Cheng ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Antihypertensive Drug ◽  
Resistant Hypertension ◽  
Composite Endpoint ◽  
Atherosclerosis Risk In Communities ◽  
Drug Classes ◽  
Atherosclerosis Risk ◽  
Aric Study

Introduction: Apparent resistant hypertension (ARH) is a common marker of risk in patients with established cardiovascular disease. We ascertained the prevalence and prognostic significance of ARH in patients without prior cardiovascular disease. Methods: This prospective observational cohort study included 9669 community-based participants without a history of heart failure, myocardial infarction, or stroke, who completed the Atherosclerosis Risk in Communities (ARIC) study visit 4 between 1996-1998. The definition of ARH was blood pressure (BP) above goal (traditional goal <140/90mmHg, more stringent goal <130/80mmHg) despite use of ≥3 antihypertensive drug classes, or any BP with ≥4 antihypertensive drug classes. Participants with controlled hypertension (CH), defined as BP at goal with use of 1-3 antihypertensive drug classes, constituted the reference group. The outcome was a composite endpoint of heart failure, myocardial infarction, stroke, or death. Cox regression models were adjusted for age, sex, race, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, glucose, and diabetes. Results: Applying the traditional BP goal, 154/9669 participants (1.6%) had ARH, and there were 2311 participants with CH (23.9%). Using the more stringent BP goal, 218/9669 participants (2.3%) had ARH, and 1523 participants (15.8 %) had CH. The median follow-up time was 19 years. Apparent resistant hypertension was associated with an increased risk for the composite endpoint (adjusted hazard ratio 1.58 [95% CI 1.32-1.90] with the traditional BP goal, and adjusted hazard ratio 1.51 [95% CI 1.28-1.79] with the more stringent BP goal). Conclusions: Apparent resistant hypertension had a low prevalence but was independently associated with adverse outcome during long term follow-up, compared to controlled hypertension and even compared to uncontrolled hypertension. This was observed for both traditional and more stringent BP goals.

scholarly journals HbA1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study

Diabetologia ◽  
2008 ◽  
Vol 51 (12) ◽  
pp. 2197-2204 ◽  
Author(s):  
A. Pazin-Filho ◽  
A. Kottgen ◽  
A. G. Bertoni ◽  
S. D. Russell ◽  
E. Selvin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

scholarly journals Metabolic syndrome and incidence of atrial fibrillation among blacks and whites in the Atherosclerosis Risk in Communities (ARIC) Study

2010 ◽  
Vol 159 (5) ◽  
pp. 850-856 ◽  
Author(s):  
Alanna M. Chamberlain ◽  
Sunil K. Agarwal ◽  
Marietta Ambrose ◽  
Aaron R. Folsom ◽  
Elsayed Z. Soliman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Metabolic Syndrome ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Blacks And Whites ◽  
Aric Study

scholarly journals Association of Atrial Fibrillation With Incidence of Extracranial Systemic Embolic Events: The ARIC Study

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Mengyuan Shi ◽  
Lin Y. Chen ◽  
Wobo Bekwelem ◽  
Faye L. Norby ◽  
Elsayed Z. Soliman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Hospital Discharges ◽  
Atherosclerosis Risk In Communities ◽  
Entire Cohort ◽  
Point Increase ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Aric Study

Background Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. Methods and Results This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA 2 DS 2 ‐VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA 2 DS 2 ‐VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA 2 DS 2 ‐VASc score was associated with increased SEE risk (HR per 1‐point increase, 1.24; 95% CI, 1.05–1.47). Conclusions AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA 2 DS 2 ‐VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

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