Hypertension, Obesity, Diabetes, and Heart Failure-Free Survival: The Cardiovascular Disease Lifetime Risk Pooling Project.
Pubmed ID: 27908389
Pubmed Central ID: PMC5582802
Journal: JACC. Heart failure
Publication Date: 12/01/2016
Affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Medicine (Cardiology), Northwestern University, Chicago, Illinois. Electronic address: email@example.com.
MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Middle Aged, Hypertension, Proportional Hazards Models, Heart Failure, Cause of Death, Incidence, Kaplan-Meier Estimate, Survival Rate, Mortality, Obesity, Diabetes Mellitus, Primary Prevention, Disease-Free Survival
Grants: R21 HL085375, T32 HL069771
Authors: Lloyd-Jones DM, Ning H, Yancy CW, Wilkins JT, Ahmad FS, Rich JD
Cite As: Ahmad FS, Ning H, Rich JD, Yancy CW, Lloyd-Jones DM, Wilkins JT. Hypertension, Obesity, Diabetes, and Heart Failure-Free Survival: The Cardiovascular Disease Lifetime Risk Pooling Project. JACC Heart Fail 2016 Dec;4(12):911-919. Epub 2016 Oct 12.
OBJECTIVES: This study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival. BACKGROUND: Quantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. METHODS: We conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m<sup>2</sup>), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin's restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival. RESULTS: For participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years. CONCLUSIONS: Prevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.