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

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

doi:10.1136/bmj.n461

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

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^*

^*Corresponding author voor dit werk

Onderzoeksoutput › Academic › peer review

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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% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 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.

Originele taal-2	English
Artikelnummer	n461
Aantal pagina's	9
Tijdschrift	BMJ (Clinical research ed.)
Volume	372
DOI's	https://doi.org/10.1136/bmj.n461
Status	Published - 23-mrt.-2021

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Age dependent associations of risk factors with heart failure_ pooled population based cohort studyFinal publisher's version, 382 KBLicentie: CC BY

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Tromp, J., Paniagua, S. M. A., Lau, E. S., Allen, N. B., Blaha, M. J., Gansevoort, R. T., Hillege, H. L., Lee, D. E., Levy, D., Vasan, R. S., van der Harst, P., van Gilst, W. H., Larson, M. G., Shah, S. J., de Boer, R. A., Lam, C. S. P., & Ho, J. E. (2021). Age dependent associations of risk factors with heart failure: pooled population based cohort study. BMJ (Clinical research ed.), 372, Artikel n461. https://doi.org/10.1136/bmj.n461

@article{b6308f62e1bb41669c2f28847c4b674a,

title = "Age dependent associations of risk factors with heart failure: pooled population based cohort study",

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% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 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.",

keywords = "Adult, Age Factors, Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Failure/epidemiology, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Risk Factors, United States/epidemiology",

author = "Jasper Tromp and Paniagua, {Samantha M A} and Lau, {Emily S} and Allen, {Norrina B} and Blaha, {Michael J} and Gansevoort, {Ron T} and Hillege, {Hans L} and Lee, {Douglas E} and Daniel Levy and Vasan, {Ramachandran S} and {van der Harst}, Pim and {van Gilst}, {Wiek H} and Larson, {Martin G} and Shah, {Sanjiv J} and {de Boer}, {Rudolf A} and Lam, {Carolyn S P} and Ho, {Jennifer E}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = mar,

day = "23",

doi = "10.1136/bmj.n461",

language = "English",

volume = "372",

journal = "BMJ (Clinical research ed.)",

issn = "0959-8138",

publisher = "BMJ Publishing Group",

}

Tromp, J, Paniagua, SMA, Lau, ES, Allen, NB, Blaha, MJ, Gansevoort, RT , Hillege, HL, Lee, DE, Levy, D, Vasan, RS, van der Harst, P , van Gilst, WH, Larson, MG, Shah, SJ, de Boer, RA , Lam, CSP & Ho, JE 2021, 'Age dependent associations of risk factors with heart failure: pooled population based cohort study', BMJ (Clinical research ed.), vol. 372, n461. https://doi.org/10.1136/bmj.n461

TY - JOUR

T1 - Age dependent associations of risk factors with heart failure

T2 - pooled population based cohort study

AU - Tromp, Jasper

AU - Paniagua, Samantha M A

AU - Lau, Emily S

AU - Allen, Norrina B

AU - Blaha, Michael J

AU - Gansevoort, Ron T

AU - Hillege, Hans L

AU - Lee, Douglas E

AU - Levy, Daniel

AU - Vasan, Ramachandran S

AU - van der Harst, Pim

AU - van Gilst, Wiek H

AU - Larson, Martin G

AU - Shah, Sanjiv J

AU - de Boer, Rudolf A

AU - Lam, Carolyn S P

AU - Ho, Jennifer E

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/3/23

Y1 - 2021/3/23

N2 - 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% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 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.

AB - 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% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 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.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Follow-Up Studies

KW - Heart Failure/epidemiology

KW - Humans

KW - Incidence

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Risk Factors

KW - United States/epidemiology

U2 - 10.1136/bmj.n461

DO - 10.1136/bmj.n461

M3 - Article

C2 - 33758001

SN - 0959-8138

VL - 372

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

M1 - n461

ER -

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

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