Cardiac and noncardiac organ dysfunction are precursors of HF
MedWire News: Cardiac dysfunction and noncardiac organ dysfunction are precursors of heart failure (HF), a sub-analysis of the Framingham Heart Study original cohort has found.
"Our prospective observations… contribute to the understanding of HF as a progressive disease syndrome and underscore the potential importance of noncardiac risk factors in predisposing to the manifestation of overt HF," write Ramachandran Vasan (Boston University School of Medicine, Massachusetts, USA) and colleagues in the journal Circulation.
The researchers studied 1038 participants of the Framingham Heart Study original cohort, with a mean age of 76 years (39% male). Left ventricular systolic and diastolic function were routinely measured. Major noncardiac organ systems were assessed using renal serum creatinine levels, hepatic serum albumin levels, ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1:FVC ratio), hemoglobin concentration, and white blood cell count.
The findings showed that over a mean follow-up period of 11 years, 248 incident HF events occurred. After adjusting for established HF risk factors including age, gender, and body mass index, antecedent left ventricular systolic dysfunction was associated with a 2.33-fold increased risk for HF. Diastolic dysfunction was associated with a 1.32-fold increased risk for HF.
Subclinical renal impairment, defined by serum creatinine level higher than 1.05 mg/dl, airflow limitation defined by FEV1:FVC ratio smaller than 91%, and anemia defined by hemoglobin concentration lower than 13 g/dl, were associated with a 30% increased risk for HF (p<0.05), after adjusting for cardiac dysfunction.
Of note, say the authors, the significant risk factors differed according to the type of HF, ie, HF with preserved ejection fraction (HFPEF) and HF with reduced ejection fraction (HFREF).
"Antecedent left ventricular systolic dysfunction, subclinical renal impairment, and lower hemoglobin concentrations were associated with a higher incidence of HFREF, whereas antecedent diastolic dysfunction and baseline airflow obstruction were related positively to the risk of future HFPEF," they report.
The study has implications for the early identification of individuals at risk for HF, with potential strategies to prevent progression to overt HF warranting further study, Vasan et al conclude.
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By Piriya Mahendra