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Cardiovascular Risk Factors in Patients with Valvular Heart Disease: A Nationwide Observational Cohort Study
Qianhong Lu1,2, Junxing Lv1,2,3,4, Zhe Li1,2
1Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
Insights
Conventional cardiovascular risk factors increase the risk of adverse outcomes in patients with valvular heart disease (VHD), particularly mitral regurgitation. Managing these risk factors is crucial for improving patient prognosis and secondary prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Valvular heart disease (VHD) is a significant cardiovascular condition.
- Conventional cardiovascular risk factors are increasingly recognized as potential contributors to VHD development and progression.
Purpose of the Study:
- To investigate the prevalence of modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidemia, diabetes) in patients with VHD.
- To assess the impact of these risk factors on patient outcomes.
- To identify prognostic indicators in VHD patients with varying risk factor burdens.
Main Methods:
- A cohort study involving 11,862 patients with moderate or greater VHD.
- Primary outcome: a composite of all-cause mortality, heart failure hospitalization, and myocardial infarction within two years.
- Analysis of risk factor distribution and their association with outcomes, stratified by VHD type and etiology.
Main Results:
- The study included 11,862 patients with VHD, with a mean age of 61.77 years and 44.4% females.
- Prevalence of risk factors: hypertension (45.0%), smoking (14.9%), diabetes (14.5%), and hyperlipidemia (13.4%).
- An increasing number of risk factors was independently associated with poorer two-year outcomes in patients with mitral regurgitation (MR), with a 17.3% higher risk of adverse events per additional risk factor in secondary MR. Females with three or four risk factors had poorer outcomes than males.
Conclusions:
- Over 20% of VHD patients had at least two conventional cardiovascular risk factors.
- The number of risk factors is a significant indicator of poor prognosis in patients with significant MR.
- Optimizing the management of cardiovascular risk factors is essential for improving secondary prevention and long-term outcomes in VHD patients.
Purpose:
Conventional cardiovascular risk factors may contribute to the development of valvular heart disease (VHD). The present study sought to investigate the distribution of conventional modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidemia, and diabetes) in various VHDs, the impact of risk factors on outcomes, and the prognostic indicators in patients with distinct burdens of risk factors.
Patients And Methods:
The study included 11862 patients with moderate or greater VHD. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure, and myocardial infarction within two years.
Results:
Of 11862 patients with VHD, the mean age was 61.77 ± 13.51 years, and 44.4% were female. The prevalences of smoking, hypertension, hyperlipidemia, and diabetes were 14.9%, 45.0%, 13.4%, and 14.5% in the total cohort. Patients with zero, one, two, three, or four risk factors accounted for 39.4%, 38.2%, 17.7%, 4.3%, and 0.3%, respectively. The number of conventional risk factors was independently associated with two-year outcome in patients with mitral regurgitation (MR; three/four vs zero: hazard ratio [HR, 95% confidence interval (CI)]: 1.600 [1.106-2.315], P = 0.013; two vs zero: HR [95% CI]: 1.153 [0.867-1.532], P = 0.328; one vs zero: HR [95% CI]: 0.892 [0.687-1.159], P = 0.393). Stratified by the etiology of mitral valve lesions, each one risk factor increase was independently related to a 17.3% higher risk of adverse events in secondary MR. In patients with three or four risk factors, females had a significantly poorer outcome than males (P = 0.002).
Conclusion:
More than one of five VHD patients had at least two conventional cardiovascular risk factors. The increasing number of risk factors indicated poor prognosis in patients with significant MR. Optimizing risk factor control may improve secondary prevention as well as long-term outcomes of VHD.
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