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Risk factors for heart failure in patients with one prior myocardial infarction episode
Teodora Mocan1, Lucia Agoşton-Coldea, M Gatfossé
1Department of Normal Morphology and Functions, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. teodora_mocan@yahoo.com
Insights
In patients with myocardial infarction, high C-reactive protein and glycaemia levels, and low HDL-Cholesterol increase heart failure risk. Managing these factors can significantly reduce the likelihood of developing heart failure after a heart attack.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Myocardial infarction is a significant risk factor for heart failure (HF).
- Classical HF risk factors include hypertension, diabetes, obesity, and dyslipidemia.
- Emerging factors like inflammation and insulin resistance require further investigation in HF patients.
Purpose of the Study:
- To evaluate factors contributing to heart failure development in patients with a history of myocardial infarction.
- To identify independent predictors of heart failure in this patient cohort.
Main Methods:
- A cross-sectional study of 144 patients with prior myocardial infarction.
- Patients were categorized based on the presence or absence of heart failure (NYHA classification and LVEF < 40%).
- Univariate, multivariate, and ROC analyses were employed to identify independent predictors.
Main Results:
- Hypertension, diabetes, smoking, obesity, elevated C-reactive protein, triglycerides, and glycaemia were significant in univariate analysis.
- Multivariate analysis identified C-reactive protein (CRP), glycaemia, and HDL-Cholesterol as independent predictors.
- Highest risk was associated with CRP levels ≥ 24mg/dL, glycaemia levels ≥ 114 mg/dL, and HDL-Cholesterol < 32 mg/dL.
Conclusions:
- Reducing C-reactive protein and glycaemia levels is crucial for mitigating heart failure risk post-myocardial infarction.
- Increasing HDL-Cholesterol levels may also contribute to reducing heart failure incidence.
- Targeting these modifiable factors offers a promising strategy for heart failure prevention in myocardial infarction survivors.
Background And Aim:
Myocardial infarction is an important risk factor for HF, increasing risk 2- to 3-fold. Other identified classical risk factors for HF include left ventricular hypertrophy, valvular heart disease, hypertension, diabetes mellitus, cigarette smoking, obesity, and dyslipidaemia. New mechanisms, such as insulin resistance, inflammation, and oxidative stress, have been investigated, but the importance of many of these mechanisms is largely unexplored in patients of HF. Our aim was to evaluate the factors involved in heart failure installation in patients with prior myocardial infarction.
Methods:
We performed a cross-sectional study including 144 patients presenting old, certified myocardial infarction. Patients were divided into two groups according to presence/absence of heart failure, as certified by New York Heart Association (NYHA) classification of heart and of echocardiography criteria by left ventricular ejection fraction < 40%. Univariate and multivariate models were performed to identify the independent predictors of heart failure. Also, receiver operating characteristic analysis doubled by chi square test for trend was performed to analyze the risk impact of each identified predictor.
Results:
Univariate between groups comparison was significant for hypertension (p = 0.001), diabetes mellitus (p < 0.001), smoking status (p < 0.001), obesity (p = 0.027), waist circumference (p < 0.001), and levels of C-reactive protein (p < 0.001), total cholesterol (p = 0.008), triglycerides (p = 0.003), HDL-Cholesterol (p < 0.001), glycaemia (p < 0.001) and brain natriuretic peptide (p < 0.001). Multivariate analysis selected C-reactive protein (OR = 2.7, 95% CI = 1.9-4.9, p < 0.001), glycaemia (OR = 2.1, 95% CI = 1.2-4.5, p = 0.027) and HDL-Cholesterol (OR = 0.7, 95% CI = 0.3-0.9, p = 0.035) as independent predictors. Separate across quintile test for trend revealed that the highest risk is added by levels of C-reactive protein levels > = 24mg/dL, followed by glycaemia levels > = 114 mg/dL and HDL-Cholesterol < 32 mg/dL.
Conclusions:
Reducing of C-reactive protein and glycaemia levels, as well as increasing the level of HDL-Cholesterol may add a great benefit in reducing heart failure installation risk in patients with myocardial infarction.
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