Age dependent associations of risk factors with heart failure: pooled population based cohort study.

Citation
Tromp, J., et al. “Age Dependent Associations Of Risk Factors With Heart Failure: Pooled Population Based Cohort Study.”. Bmj (Clinical Research Ed.), p. n461.
Center UCSD-UCLA
Author Jasper Tromp, Samantha M A Paniagua, Emily S Lau, Norrina B Allen, Michael J Blaha, Ron T Gansevoort, Hans L Hillege, Douglas E Lee, Daniel Levy, Ramachandran S Vasan, Pim van der Harst, Wiek H van Gilst, Martin G Larson, Sanjiv J Shah, Rudolf A de Boer, Carolyn S P Lam, Jennifer E Ho
Abstract

OBJECTIVE: To assess age differences in risk factors for incident heart failure in the general population.

DESIGN: Pooled population based cohort study.

SETTING: Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.

PARTICIPANTS: 24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals.

MAIN OUTCOME MEASURE: Incident heart failure.

RESULTS: Over a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% 53% in elderly participants), with better model performance (C index 0.79 0.64). Similarly, the population attributable risks of obesity (21% 13%), hypertension (35% 23%), diabetes (14% 7%), and current smoking (32% 1%) were higher in young compared with elderly participants.

CONCLUSIONS: Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.

Year of Publication
2021
Journal
BMJ (Clinical research ed.)
Volume
372
Number of Pages
n461
Date Published
12/2021
ISSN Number
1756-1833
DOI
10.1136/bmj.n461
Alternate Journal
BMJ
PMID
33758001
PMCID
PMC7986583