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Predicted Risk, Preclinical Heart Failure Measures, and Incident Heart Failure: The ARIC Study
Jelani K Grant1, Sui Zhang2, Sadiya S Khan3
1Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
Insights
Preclinical heart failure (HF) measures identify higher absolute HF risk within PREVENT-HF categories. Adding these measures, particularly cardiac biomarkers, significantly enhances HF risk prediction and discrimination.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers and Diagnostics
Background:
- The predictive utility of PREVENT-HF risk estimates for preclinical heart failure (HF) is not well-defined.
- The added value of preclinical HF measures to existing risk scores like PREVENT-HF requires further investigation.
Purpose of the Study:
- To assess the association between PREVENT-HF risk estimates and preclinical HF.
- To determine how preclinical HF indicators correlate with absolute HF risk across PREVENT-HF categories.
- To evaluate if preclinical HF measures improve HF risk prediction beyond the PREVENT-HF score.
Main Methods:
- Prospective analysis of 2,714 Atherosclerosis Risk In Communities (ARIC) participants without cardiovascular disease.
- Preclinical HF defined by elevated cardiac biomarkers (NT-proBNP, hs-cTnT) and/or abnormal echocardiography.
- Prevalence and incidence of HF were analyzed across PREVENT-HF 10-year risk strata, with and without preclinical HF markers.
Main Results:
- Higher PREVENT-HF risk was linked to increased preclinical HF prevalence.
- Within the highest PREVENT-HF risk category (≥20%), HF incidence was substantially higher in those with preclinical HF (51.5 vs. 9.5 per 1,000 person-years).
- Adding cardiac biomarkers to PREVENT-HF significantly improved risk discrimination (C-statistic 0.69 to 0.75) and reclassification.
Conclusions:
- Preclinical HF measures are associated with elevated absolute HF risk within PREVENT-HF risk categories.
- Incorporating preclinical HF indicators, especially cardiac biomarkers, enhances the predictive accuracy of the PREVENT-HF score for heart failure.
Background:
The association of PREVENT-HF (Predicting Risk of Cardiovascular Events-Heart Failure) risk estimates with preclinical heart failure (HF) and whether preclinical HF measures add to the predictive utility of PREVENT-HF remain undefined.
Objectives:
The aims of this study were to evaluate the association between PREVENT-HF risk estimates and preclinical HF, to examine how preclinical HF measures correspond to absolute HF risk within PREVENT-HF categories, and to determine whether they provide predictive value beyond the PREVENT-HF score.
Methods:
The authors performed a prospective analysis of 2,714 ARIC (Atherosclerosis Risk In Communities) Visit 5 participants <80 years of age, without baseline cardiovascular disease. Preclinical HF was defined by elevated cardiac biomarkers (N-terminal of pro-b-type natriuretic peptide ≥125 pg/mL or high-sensitivity cardiac troponin T ≥22 ng/L/≥14 ng/L in men/women) and/or abnormal echocardiographic findings. Within PREVENT-HF 10-year risk categories (<7.5%, ≥7.5% to <10%, ≥10% to <15%, ≥15% to <20%, and ≥20%), we assessed preclinical HF prevalence and compared 10-year HF incidence rates for those with and without preclinical HF. We assessed changes in predictive utility by adding preclinical HF measures to PREVENT-HF.
Results:
The mean age was 74 years, with 63% women, and 22% Black adults. Higher PREVENT-HF risk was associated with higher preclinical HF prevalence, with the highest prevalence of combined elevated biomarkers plus abnormal echocardiograms (37%) in those with PREVENT-HF ≥20%. Over a median follow-up of 9.9 years, 262 HF events occurred. Within PREVENT-HF categories, preclinical HF measures were strongly associated with absolute HF risk: among those with PREVENT-HF ≥20%, HF incidence rates (per 1,000 person-years) were 9.5 with no preclinical HF and 51.5 with elevated biomarkers plus abnormal echocardiography. Adding cardiac biomarkers to PREVENT-HF improved risk discrimination (C statistic change 0.69 to 0.75; P < 0.001) and reclassification (categorical Net Reclassification Index: 0.17; 95% CI: 0.09-0.26), with modest further improvement from adding echocardiographic measures.
Conclusions:
Preclinical HF measures indicate higher absolute HF risk within PREVENT-HF categories and enhance HF risk prediction.
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