Age dependent associations of risk factors with heart failure: pooled population based cohort study

AbstractObjectiveTo assess age differences in risk factors for incident heart failure in the general population.DesignPooled population based cohort study.SettingFramingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.Participants24...

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Veröffentlicht in:BMJ (Online) Jg. 372; S. n461
Hauptverfasser: Tromp, Jasper, Paniagua, Samantha M A, Lau, Emily S, Allen, Norrina B, Blaha, Michael J, Gansevoort, Ron T, Hillege, Hans L, Lee, Douglas E, Levy, Daniel, Vasan, Ramachandran S, van der Harst, Pim, van Gilst, Wiek H, Larson, Martin G, Shah, Sanjiv J, de Boer, Rudolf A, Lam, Carolyn S P, Ho, Jennifer E
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England British Medical Journal Publishing Group 23.03.2021
BMJ Publishing Group LTD
BMJ Publishing Group Ltd
Schlagworte:
Adult
Age
Age differences
Age Factors
Age groups
Aged
Aged, 80 and over
Antihypertensives
Arteriosclerosis
Blood pressure
Body mass index
Cardiac arrhythmia
Cohort analysis
Congestive heart failure
Diabetes
Diabetes mellitus
Ejection fraction
End-stage renal disease
Female
Follow-Up Studies
Heart attacks
Heart failure
Heart Failure - epidemiology
Heart Failure - etiology
Humans
Hypertension
Incidence
Kaplan-Meier Estimate
Kidney diseases
Male
Middle age
Middle Aged
Myocardial infarction
Population
Population studies
Population-based studies
Proportional Hazards Models
Risk Factors
Smoking
United States - epidemiology
Variables
United States
ISSN:1756-1833, 0959-8138, 1756-1833
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Zusammenfassung:AbstractObjectiveTo assess age differences in risk factors for incident heart failure in the general population.DesignPooled population based cohort study.SettingFramingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.Participants24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals.Main outcome measureIncident heart failure.ResultsOver a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 1%) were higher in young compared with elderly participants.ConclusionsDespite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.
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ISSN:1756-1833
0959-8138
1756-1833
DOI:10.1136/bmj.n461