Body weight in midlife and long-term risk of developing heart failure-a 35-year follow-up of the primary prevention study in Gothenburg, Sweden

Abstract Background: Previous studies suggested an adverse association between higher fasting blood glucose (FBG) and heart failure. However, FBG values fluctuate continuously over time, the association between FBG variability and the risk of heart failure is uncertain.Aims: We investigated the relationship between visit-to-visit variability in FBG and the risk of new-onset heart failure.Methods and Results: This was a population-based cohort study using the Kailuan dataset, which comprises of medical claims and a biennially health checkup information from a Chinese cohort. A total of 98 554 individuals (mean age: 53.63 years) who had at least two health checkups with FBG measurement between 2006 and 2012 without preexisting heart failure were included. FBG variability was calculated using the variability independent of the mean, coefficient of variation, standard deviation, and average successive variability (ARV). Participants were divided into quartiles of ARV. Cox regression was used to identify heart failure. Over a mean follow-up of 6.27 years, 1218 individuals developed heart failure. The incidence of heart failure was 1.97 per 1000 person-years. After adjusting for baseline FBG and other potential confounders, individuals in the highest quartile of the ARV of FBG had 32.6% higher risk of developing heart failure compared to those in the lowest quartile (hazard ratio, 1.326; 95% confidence interval, 1.120-1.570). This association remained significant in patients with or without prevalent hypertension. In subgroup analyses, individuals who were younger (<65 years), without diabetes mellitus or chronic kidney disease, and with a body mass index<25 kg/m2 experienced a higher risk of heart failure.Conclusions: Our data demonstrated that high FBG variability is independently associated with the development of new-onset heart failure. Future studies should explore whether measures to reduce variability can lead to improve clinical outcomes. Trial registration: Chinese Clinical Trial Register, ChiCTR-TNRC-11001489. Registered on 24-08-2011.

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Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase

Allergy ◽

10.1111/j.1398-9995.2008.01778.x ◽

2008 ◽

Vol 63 (11) ◽

pp. 1481-1490 ◽

Cited By ~ 60

Author(s):

S. L. Prescott ◽

J. Wiltschut ◽

A. Taylor ◽

L. Westcott ◽

W. Jung ◽

...

Keyword(s):

Primary Prevention ◽

Allergic Disease ◽

Prevention Study ◽

Early Markers ◽

Primary Prevention Study

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Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0983 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Huang ◽

C Liu

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Funding Source ◽

Preserved Ejection Fraction ◽

Risk Of Mortality ◽

All Cause Mortality ◽

History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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