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Modifiable risk factors for incident heart failure in the coronary artery surgery study
R M Hoffman1, B M Psaty, R A Kronmal
1Medical Service, Seattle Veterans Affairs Medical Center, Wash.
Insights
Smoking and excess weight are independent risk factors for heart failure in patients with coronary artery disease. Interventions targeting smoking cessation and weight reduction may help prevent heart failure development.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Heart failure (HF) significantly contributes to morbidity and mortality despite aggressive treatments.
- Primary prevention of HF is gaining importance, necessitating the identification of modifiable risk factors.
- Coronary artery disease (CAD) patients are particularly vulnerable to HF development.
Purpose of the Study:
- To investigate if modifiable cardiovascular risk factors are independent predictors of incident heart failure.
- To assess the role of systolic and diastolic blood pressure, glucose, cholesterol, weight, and smoking in HF development.
- To analyze these risk factors in patients with anatomically confirmed coronary artery disease.
Main Methods:
- Utilized data from the Coronary Artery Surgery Study (CASS) cohort.
- Identified incident heart failure cases through hospital discharge records, mortality data, and follow-up questionnaires.
- Employed Cox regression analysis to determine adjusted relative risks for heart failure.
Main Results:
- The 12-year cumulative incidence of heart failure was 20.6%.
- Smoking (RR, 1.47) and increased weight (RR, 1.15 per 10 kg) were independently associated with incident heart failure.
- Myocardial infarction, older age, female sex, and baseline left ventricular dysfunction also predicted heart failure.
Conclusions:
- Patients with stable coronary artery disease face a high risk of developing heart failure, particularly after myocardial infarction.
- Smoking cessation and weight reduction represent potential interventions to prevent clinical heart failure in this high-risk population.
- Modifiable risk factors play a crucial role in the primary prevention of heart failure among CAD patients.
Background:
Even with aggressive treatment, heart failure is associated with a substantial morbidity and mortality. This poor prognosis has led to increasing interest in primary prevention, and the identification of modifiable risk factors. Our objective was to determine whether modifiable cardiovascular risk factors, including systolic and diastolic blood pressure, fasting glucose level, cholesterol level, weight, and smoking, were independent risk factors for heart failure in patients with anatomically confirmed coronary artery disease.
Methods:
We studied all patients with documented coronary artery disease eligible for the multicenter, randomized-controlled Coronary Artery Surgery Study. After excluding 79 prevalent cases, we identified incident cases of heart failure using hospital discharge abstracts, mortality records, or self-reported follow-up questionnaires. Criteria for self-reported cases were treatment with digitalis and/or furosemide plus two or more heart failure symptoms, including dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or edema. Cox regression analysis was used to estimate adjusted relative risks.
Results:
At 12-year follow-up, the cumulative incidence of heart failure was 20.6%. Smoking (relative risk, 1.47) and weight (relative risk, 1.15/10 kg) were independently associated with incident heart failure. Myocardial infarction during follow-up, age, female sex, and baseline left ventricular dysfunction were also risk factors for heart failure.
Conclusions:
Patients with stable coronary artery disease are at high risk for developing heart failure, especially following myocardial infarction. However, interventions aimed at smoking cessation and weight reduction may prevent clinical heart failure in these patients.