Predictors of New-Onset Heart Failure

Circulation: Heart Failure - Tập 6 Số 2 - Trang 279-286 - 2013
Jennifer E. Ho1, Asya Lyass1, Douglas S. Lee1, Ramachandran S. Vasan1, William B. Kannel1, Martin G. Larson1, Daniel Levy1
1From the National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA (J.E.H., A.L., R.S.V., W.B.K., M.G.L., D.L.); Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD (J.E.H., D.L.); Cardiovascular Medicine Section, Department of Medicine, Boston University Medical Center, Boston, MA (J.E.H.); Department of Mathematics and Statistics, Boston University, Boston, MA (A.L., M.G.L.); Institute for Clinical Evaluative Sciences, Toronto, Ontario,...

Tóm tắt

Background— About one half of patients with heart failure (HF) have preserved ejection fraction (HFPEF) rather than reduced ejection fraction (HFREF). The differences in risk factors predisposing to the 2 subtypes of HF are poorly understood. We sought to identify clinical predictors of new-onset HF and to explore differences in HFPEF versus HFREF. Methods and Results— We studied new-onset HF cases between 1981 and 2008 in Framingham Heart Study participants, classified into HFPEF and HFREF (ejection fraction >45% versus ≤45%). We used Cox multivariable regression to examine predictors of 8-year risk of incident HF and competing-risks analysis to identify predictors that differed between HFPEF and HFREF. Among 6340 participants (60±12 years) with 97 808 person-years of follow-up, 512 developed incident HF. Of 457 participants with left ventricular ejection fraction evaluation at the time of HF diagnosis, 196 (43%) were classified as HFPEF and 261 (56%) as HFREF. Fourteen predictors of overall HF were identified. Older age, diabetes mellitus, and a history of valvular disease predicted both types of HF ( P ≤0.0025 for all). Higher body mass index, smoking, and atrial fibrillation predicted HFPEF only, whereas male sex, higher total cholesterol, higher heart rate, hypertension, cardiovascular disease, left ventricular hypertrophy, and left bundle-branch block predicted risk of HFREF. Conclusions— Although multiple risk factors preceded overall HF, distinct clusters of risk factors determine risk for new-onset HFPEF versus HFREF. This knowledge may enable the design of clinical trials of targeted prevention and the introduction of therapeutic strategies for prevention of HF and its 2 major subtypes.

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Tài liệu tham khảo

10.1161/CIRCULATIONAHA.109.192667

10.1016/j.jacc.2003.07.046

10.1056/NEJMoa052256

10.1016/S0002-9149(00)01165-6

10.1001/jama.296.18.2209

10.1056/NEJMoa051530

10.1016/S0002-9149(00)01393-X

10.1016/j.pcad.2005.02.010

10.1056/NEJM199209033271003

10.1093/eurheartj/ehn309

10.1161/CIRCULATIONAHA.109.192065

10.1111/j.1749-6632.1963.tb13299.x

10.1093/oxfordjournals.aje.a112813

Cupples LA D’Agostino RB. The Framingham Study section 35. An Epidemiologic Investigation of Cardiovascular Disease: Survival Following Initial Cardiovascular Events: 30 Year Follow-up. Bethesda MD: National Heart Lung and Blood Institute; NIH publication No. 88-2969; 1988.

10.1056/NEJM197112232852601

10.1161/CIRCULATIONAHA.108.815944

10.1080/01621459.1993.10476289

10.2307/2532940

10.1001/archinte.159.11.1197

10.1161/CIRCHEARTFAILURE.108.768457

10.1001/archinternmed.2009.40

10.1161/circheartfailure.109.904300

10.1161/circheartfailure.110.938175

10.1161/CIRCHEARTFAILURE.111.964841

10.1016/S0735-1097(02)02696-7

10.1016/j.ehj.2004.06.006

10.1016/S0002-9343(00)00601-X

10.1016/S0002-9343(99)80250-2

10.1016/S0002-9149(96)00719-9

10.1016/S0140-6736(03)13501-5

10.7326/0003-4819-138-11-200306030-00012

10.1016/0002-9149(91)90174-J

10.1016/0002-9149(93)90678-6

10.1016/S0735-1097(98)00347-7

10.1056/NEJMoa020245

10.1016/j.amjcard.2011.11.054

10.1161/circheartfailure.110.959890

10.1056/NEJM198501313120504

10.1093/oxfordjournals.aje.a112408

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Circulation: Heart Failure

Tập 6 Số 2

279-286

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