Author + information
- Received September 16, 2019
- Revision received November 4, 2019
- Accepted November 6, 2019
- Published online January 27, 2020.
- Danielle M. Kubicki, BSa,
- Meng Xu, MSb,c,
- Elvis A. Akwo, MD, PhDb,d,
- Debra Dixon, MD, MSb,e,
- Daniel Muñoz, MDb,e,
- William J. Blot, PhDf,
- Thomas J. Wang, MDb,e,
- Loren Lipworth, ScDb,f,∗ and
- Deepak K. Gupta, MD, MSCIb,e,∗∗ ()
- aVanderbilt University School of Medicine, Nashville, Tennessee
- bVanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
- cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- dDivision of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
- eDivision of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- fDivision of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Deepak K. Gupta, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 300-A, Nashville, Tennessee 37203.
Objectives The purpose of this study was to examine race- and sex-based variation in the associations between modifiable risk factors and incident heart failure (HF) among the SCCS (Southern Community Cohort Study) participants.
Background Low-income individuals in the southeastern United States have high HF incidence rates, but relative contributions of risk factors to HF are understudied in this population.
Methods We studied 27,078 black or white SCCS participants (mean age: 56 years, 69% black, 63% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services. The presence of hypertension, diabetes mellitus, physical underactivity, high body mass index, smoking, high cholesterol, and poor diet was assessed at enrollment. Incident HF was ascertained using International Classification of Diseases-9th revision, codes 428.x in Centers for Medicare and Medicaid Services data through December 31, 2010. Individual risk and population attributable risk for HF for each risk factor were quantified using multivariable Cox models.
Results During a median (25th, 75th percentile) 5.2 (3.1, 6.7) years, 4,341 (16%) participants developed HF. Hypertension and diabetes were associated with greatest HF risk, whereas hypertension contributed the greatest population attributable risk, 31.8% (95% confidence interval: 27.3 to 36.0). In black participants, only hypertension and diabetes associated with HF risk; in white participants, smoking and high body mass index also associated with HF risk. Physical underactivity was a risk factor only in white women.
Conclusions In this high-risk, low-income cohort, contributions of risk factors to HF varied, particularly by race. To reduce the population burden of HF, interventions tailored for specific race and sex groups may be warranted.
↵∗ Drs. Lipworth and Gupta contributed equally to this work.
The SCCS is supported by the National Cancer Institute (grants R01 CA092447 and U01 CA202979) and supplemental funding from the American Recovery and Reinvestment Act (3R01 CA029447-0851). Data collection was performed by the Survey and Biospecimen Shared Resource, which is supported by the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee (P30 CA68485). Dr. Gupta is supported by K23 HL128928-01A1. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 16, 2019.
- Revision received November 4, 2019.
- Accepted November 6, 2019.
- 2020 American College of Cardiology Foundation
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