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Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community.
JACC Heart Fail. 2016 10; 4(10):808-815.JH

Abstract

OBJECTIVES

The purpose of this study was to describe the prevalence and prognosis of HF stages in the community; to evaluate if preclinical HF stages are characterized by elevation of pro-inflammatory (C-reactive protein), neurohormonal activation (B-type natriuretic peptide, renin and aldosterone), and cardiac stress biomarkers (high-sensitivity troponin I, ST-2, and growth differentiation factor-15).

BACKGROUND

The American Heart Association/American College of Cardiology heart failure (HF) classification has 3 stages. Knowledge regarding the community burden of HF stages is limited, and data on the biomarker profile associated with HF stages are scarce, although higher concentrations of certain biomarkers are associated with preclinical HF.

METHODS

We evaluated 6,770 participants (mean age 51 years; 54% women) from the Framingham Study, defining 4 stages: 1) healthy: no risk factors; 2) stage A: presence of HF risk factors (hypertension, diabetes, obesity, coronary artery disease), no cardiac structural/functional abnormality; 3) stage B: presence of prior myocardial infarction, valvular disease, left ventricular (LV) systolic dysfunction, LV hypertrophy, regional wall motion abnormality, or LV enlargement; 4) stage C/D: prevalent HF.

RESULTS

The prevalence of HF stages A and B were 36.5% and 24.2%, respectively, rising with age (odds ratio: 1.70 [95% confidence interval: 1.64 to 1.77] per decade increment). In age- and sex-adjusted models, we observed a gradient of increasing biomarker levels across HF stages (p < 0.05; n = 3,416). Adjusting for age and sex, mortality rose across HF stages (232 deaths, mean follow-up 7 years), with 2- and 8-fold mortality risks for stages B and C/D, respectively, compared with healthy.

CONCLUSIONS

Approximately 60% of our sample has preclinical HF, and those in stage B had higher concentrations of HF biomarkers and experienced a substantial mortality risk.

Authors+Show Affiliations

Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, Massachusetts. Electronic address: vanessax@bu.edu.Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.Framingham Heart Study, Framingham, Massachusetts.Veterans Administration Hospital, West Roxbury, Massachusetts.Framingham Heart Study, Framingham, Massachusetts; Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, Massachusetts.Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Cardiology Division, Vanderbilt University Medical Center, Nashville, Tennessee.Cardiovascular Engineering, Inc., Norwood, Massachusetts.Framingham Heart Study, Framingham, Massachusetts; Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27395350

Citation

Xanthakis, Vanessa, et al. "Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community." JACC. Heart Failure, vol. 4, no. 10, 2016, pp. 808-815.
Xanthakis V, Enserro DM, Larson MG, et al. Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community. JACC Heart Fail. 2016;4(10):808-815.
Xanthakis, V., Enserro, D. M., Larson, M. G., Wollert, K. C., Januzzi, J. L., Levy, D., Aragam, J., Benjamin, E. J., Cheng, S., Wang, T. J., Mitchell, G. F., & Vasan, R. S. (2016). Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community. JACC. Heart Failure, 4(10), 808-815. https://doi.org/10.1016/j.jchf.2016.05.001
Xanthakis V, et al. Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community. JACC Heart Fail. 2016;4(10):808-815. PubMed PMID: 27395350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence, Neurohormonal Correlates, and Prognosis of Heart Failure Stages in the Community. AU - Xanthakis,Vanessa, AU - Enserro,Danielle M, AU - Larson,Martin G, AU - Wollert,Kai C, AU - Januzzi,James L, AU - Levy,Daniel, AU - Aragam,Jayashri, AU - Benjamin,Emelia J, AU - Cheng,Susan, AU - Wang,Thomas J, AU - Mitchell,Gary F, AU - Vasan,Ramachandran S, Y1 - 2016/07/06/ PY - 2015/12/07/received PY - 2016/03/22/revised PY - 2016/05/02/accepted PY - 2016/7/11/entrez PY - 2016/7/11/pubmed PY - 2017/12/22/medline KW - biomarkers KW - echocardiography KW - epidemiology KW - heart failure stages SP - 808 EP - 815 JF - JACC. Heart failure JO - JACC Heart Fail VL - 4 IS - 10 N2 - OBJECTIVES: The purpose of this study was to describe the prevalence and prognosis of HF stages in the community; to evaluate if preclinical HF stages are characterized by elevation of pro-inflammatory (C-reactive protein), neurohormonal activation (B-type natriuretic peptide, renin and aldosterone), and cardiac stress biomarkers (high-sensitivity troponin I, ST-2, and growth differentiation factor-15). BACKGROUND: The American Heart Association/American College of Cardiology heart failure (HF) classification has 3 stages. Knowledge regarding the community burden of HF stages is limited, and data on the biomarker profile associated with HF stages are scarce, although higher concentrations of certain biomarkers are associated with preclinical HF. METHODS: We evaluated 6,770 participants (mean age 51 years; 54% women) from the Framingham Study, defining 4 stages: 1) healthy: no risk factors; 2) stage A: presence of HF risk factors (hypertension, diabetes, obesity, coronary artery disease), no cardiac structural/functional abnormality; 3) stage B: presence of prior myocardial infarction, valvular disease, left ventricular (LV) systolic dysfunction, LV hypertrophy, regional wall motion abnormality, or LV enlargement; 4) stage C/D: prevalent HF. RESULTS: The prevalence of HF stages A and B were 36.5% and 24.2%, respectively, rising with age (odds ratio: 1.70 [95% confidence interval: 1.64 to 1.77] per decade increment). In age- and sex-adjusted models, we observed a gradient of increasing biomarker levels across HF stages (p < 0.05; n = 3,416). Adjusting for age and sex, mortality rose across HF stages (232 deaths, mean follow-up 7 years), with 2- and 8-fold mortality risks for stages B and C/D, respectively, compared with healthy. CONCLUSIONS: Approximately 60% of our sample has preclinical HF, and those in stage B had higher concentrations of HF biomarkers and experienced a substantial mortality risk. SN - 2213-1787 UR - https://www.unboundmedicine.com/medline/citation/27395350/Prevalence_Neurohormonal_Correlates_and_Prognosis_of_Heart_Failure_Stages_in_the_Community_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-1779(16)30204-9 DB - PRIME DP - Unbound Medicine ER -