1. Association of Midlife Cardiovascular Risk Factors With the Risk of Heart Failure Subtypes Later in Life
- Author
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Yiyi Zhang, Norrina B. Allen, Mark J. Pletcher, Andrew E. Moran, Eric Vittinghoff, Sanjiv J. Shah, Laura P. Cohen, Patricia P. Chang, John T. Wilkins, Diane G. Ives, Anne B. Newman, Elizabeth C. Oelsner, Mathew S. Maurer, and Chiadi E Ndumele
- Subjects
Adult ,Male ,heart failure with preserved ejection fraction ,medicine.medical_specialty ,Aging ,Clinical Sciences ,Nursing ,030204 cardiovascular system & hematology ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Clinical Research ,Internal medicine ,Medicine ,Humans ,2.1 Biological and endogenous factors ,heart failure with reduced ejection fraction ,030212 general & internal medicine ,Risk factor ,Aetiology ,Heart Failure ,midlife ,Ejection fraction ,business.industry ,Prevention ,Stroke Volume ,medicine.disease ,Prognosis ,Atherosclerosis ,Pulse pressure ,Blood pressure ,Heart Disease ,Good Health and Well Being ,Heart failure subtype ,Cardiovascular System & Hematology ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Heart failure ,Hypertension ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction ,Body mass index ,Cohort study - Abstract
Background Independent associations between cardiovascular risk factor exposures during midlife and later life development of heart failure (HF) with preserved ejection fraction (HFpEF) versus reduced EF (HFrEF) have not been previously studied. Methods We pooled data from 4 US cohort studies (Atherosclerosis Risk in Communities, Cardiovascular Health, Health , Aging and Body Composition, and Multi-Ethnic Study of Atherosclerosis) and imputed annual risk factor trajectories for body mass index, systolic and diastolic blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol, and glucose starting from age 40 years. Time-weighted average exposures to each risk factor during midlife and later life were calculated and analyzed for associations with the development of HFpEF or HFrEF. Results A total of 23,861 participants were included (mean age at first in-person visit, 61.8 ±1 0.2 years; 56.6% female). During a median follow-up of 12 years, there were 3666 incident HF events, of which 51% had EF measured, including 934 with HFpEF and 739 with HFrEF. A high midlife systolic blood pressure and low midlife high-density lipoprotein cholesterol were associated with HFrEF, and a high midlife body mass index, systolic blood pressure, pulse pressure, and glucose were associated with HFpEF. After adjusting for later life exposures, only midlife pulse pressure remained independently associated with HFpEF. Conclusions Midlife exposure to cardiovascular risk factors are differentially associated with HFrEF and HFpEF later in life. Having a higher pulse pressure during midlife is associated with a greater risk for HFpEF but not HFrEF, independent of later life exposures.
- Published
- 2021