Author + information
- Received April 27, 2016
- Revision received August 10, 2016
- Accepted August 10, 2016
- Published online December 1, 2016.
- Faraz S. Ahmad, MDa,b,
- Hongyan Ning, MD, MSa,
- Jonathan D. Rich, MDb,
- Clyde W. Yancy, MD, MScb,
- Donald M. Lloyd-Jones, MD, ScMa,b and
- John T. Wilkins, MD, MSa,b,∗ ()
- aDepartment of Preventive Medicine, Northwestern University, Chicago, Illinois
- bDepartment of Medicine (Cardiology), Northwestern University, Chicago, Illinois
- ↵∗Reprint requests and correspondence:
Dr. John T. Wilkins, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lakeshore Drive, Suite 1400, Chicago, Illinois 60091.
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/m2), 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.
The Cardiovascular Disease Lifetime Risk Pooling has been supported by R21 HL085375 from the National Heart, Lung, and Blood Institute (NHLBI) and by institutional funds from Northwestern University Feinberg School of Medicine. This study was conducted with the use of limited-access datasets obtained by the NHLBI and does not necessarily reflect the opinions or views of the study investigators or the NHLBI. The ARIC study, Framingham Heart study, and the Framingham Offspring study are conducted and supported by the NHLBI in collaboration with the study investigators. Dr. Ahmad is supported by the NHLBI of the National Institutes of Health under Award number T32HL069771 and by a 2015 Research Fellowship Award from the Heart Failure Society of America. Dr. Rich has received honoraria from Otsuka from the speaker’s bureau. Dr. Wilkins is in part supported by NIH Loan Repayment Program. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 27, 2016.
- Revision received August 10, 2016.
- Accepted August 10, 2016.
- American College of Cardiology Foundation