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Ketabi M, Andishgar A, Fereidouni Z, Sani MM, Abdollahi A, Vali M, Alkamel A, Tabrizi R. Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach. Clin Cardiol 2024; 47:e24239. [PMID: 38402566 PMCID: PMC10894620 DOI: 10.1002/clc.24239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HF patients by using The Fasa Registry on Systolic HF (FaRSH) database. HYPOTHESIS ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data. METHODS Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC). RESULTS Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI. CONCLUSIONS The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.
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Affiliation(s)
- Marzieh Ketabi
- Student Research CommitteeFasa University of Medical SciencesFasaIran
| | | | - Zhila Fereidouni
- Department of Medical Surgical NursingFasa University of Medical ScienceFarsIran
| | | | - Ashkan Abdollahi
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohebat Vali
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Abdulhakim Alkamel
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
| | - Reza Tabrizi
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
- Clinical Research Development UnitFasa University of Medical SciencesFasaIran
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2
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Nadarajah R, Younsi T, Romer E, Raveendra K, Nakao YM, Nakao K, Shuweidhi F, Hogg DC, Arbel R, Zahger D, Iakobishvili Z, Fonarow GC, Petrie MC, Wu J, Gale CP. Prediction models for heart failure in the community: A systematic review and meta-analysis. Eur J Heart Fail 2023; 25:1724-1738. [PMID: 37403669 DOI: 10.1002/ejhf.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/25/2023] [Accepted: 07/01/2023] [Indexed: 07/06/2023] Open
Abstract
AIMS Multivariable prediction models can be used to estimate risk of incident heart failure (HF) in the general population. A systematic review and meta-analysis was performed to determine the performance of models. METHODS AND RESULTS From inception to 3 November 2022 MEDLINE and EMBASE databases were searched for studies of multivariable models derived, validated and/or augmented for HF prediction in community-based cohorts. Discrimination measures for models with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using PROBAST. We included 36 studies with 59 prediction models. In meta-analysis, the Atherosclerosis Risk in Communities (ARIC) risk score (summary c-statistic 0.802, 95% confidence interval [CI] 0.707-0.883), GRaph-based Attention Model (GRAM; 0.791, 95% CI 0.677-0.885), Pooled Cohort equations to Prevent Heart Failure (PCP-HF) white men model (0.820, 95% CI 0.792-0.843), PCP-HF white women model (0.852, 95% CI 0.804-0.895), and REverse Time AttentIoN model (RETAIN; 0.839, 95% CI 0.748-0.916) had a statistically significant 95% PI and excellent discrimination performance. The ARIC risk score and PCP-HF models had significant summary discrimination among cohorts with a uniform prediction window. 77% of model results were at high risk of bias, certainty of evidence was low, and no model had a clinical impact study. CONCLUSIONS Prediction models for estimating risk of incident HF in the community demonstrate excellent discrimination performance. Their usefulness remains uncertain due to high risk of bias, low certainty of evidence, and absence of clinical effectiveness research.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tanina Younsi
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elizabeth Romer
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Yoko M Nakao
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Kazuhiro Nakao
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - David C Hogg
- School of Computing, University of Leeds, Leeds, UK
| | - Ronen Arbel
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
- Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Zaza Iakobishvili
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Community Cardiology, Clalit Health Fund, Tel Aviv, Israel
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Zimodro JM, Gasecka A, Jaguszewski M, Amanowicz S, Szkiela M, Denegri A, Pruc M, Duchnowski P, Peacock FW, Rafique Z, Szarpak L. Role of copeptin in diagnosis and outcome prediction in patients with heart failure: a systematic review and meta-analysis. Biomarkers 2022; 27:720-726. [PMID: 36083024 DOI: 10.1080/1354750x.2022.2123042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Introduction: This systematic review and meta-analysis of 19 studies, was conducted to evaluate the role of copeptin in diagnosis and outcome prediction in HF patients. Materials and Methods: A systematic literature search for clinical trials reporting copeptin levels in HF patients was performed using EMBASE, PubMed, Cochrane Register of Controlled Trials, and Google Scholar. Articles from databases published by January 2nd, 2022, that met the selection criteria were retrieved and reviewed. The random effects model was used for analyses. Results: Pooled analysis found higher mean copeptin levels in HF vs. non-HF populations (43.6 ± 46.4 vs. 21.4 ± 21.4; MD= 20.48; 95%CI: 9.22 to 31.74; p < 0.001). Pooled analysis of copeptin concentrations stratified by ejection fraction showed higher concentrations in HFrEF vs. HFpEF (17.4 ± 7.1 vs. 10.1 ± 5.5; MD= -4.69; 95%CI: -7.58 to -1.81; p = 0.001). Copeptin level was higher in patients with mortality/acute HF-related hospitalization vs. stable patients (31.3 ± 23.7 vs. 20.4 ± 12.8; MD= -13.06; 95%CI: -25.28 to -0.84; p = 0.04). Higher copeptin concentrations were associated with mortality and observed in all follow-up periods (p <0.05). Discussion and Conclusions: Present meta-analysis showed that elevated copeptin plasma concentrations observed in HF patients are associated with increased risk of all-cause mortality, thus copeptin may serve as predictor of outcome in HF.
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Affiliation(s)
- Jakub Michal Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Milosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Sandra Amanowicz
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Marta Szkiela
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Piotr Duchnowski
- Cardinal Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
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4
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Mu D, Cheng J, Qiu L, Cheng X. Copeptin as a Diagnostic and Prognostic Biomarker in Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:901990. [PMID: 35859595 PMCID: PMC9289206 DOI: 10.3389/fcvm.2022.901990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
Copeptin is the carboxyl-terminus of the arginine vasopressin (AVP) precursor peptide. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis, and regulation of endocrine stress response. Copeptin, which is released in an equimolar mode with AVP from the neurohypophysis, has emerged as a stable and simple-to-measure surrogate marker of AVP and has displayed enormous potential in clinical practice. Cardiovascular disease (CVD) is currently recognized as a primary threat to the health of the population worldwide, and thus, rapid and effective approaches to identify individuals that are at high risk of, or have already developed CVD are required. Copeptin is a diagnostic and prognostic biomarker in CVD, including the rapid rule-out of acute myocardial infarction (AMI), mortality prediction in heart failure (HF), and stroke. This review summarizes and discusses the value of copeptin in the diagnosis, discrimination, and prognosis of CVD (AMI, HF, and stroke), as well as the caveats and prospects for the application of this potential biomarker.
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Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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5
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Wannamethee SG, Papacosta O, Lennon L, Hingorani A, Whincup P. Adult height and incidence of atrial fibrillation and heart failure in older men: The British Regional Heart Study. IJC HEART & VASCULATURE 2021; 35:100835. [PMID: 34286063 PMCID: PMC8274296 DOI: 10.1016/j.ijcha.2021.100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/05/2022]
Abstract
Aims Taller stature has been associated with increased risk of atrial fibrillation (AF). AF and heart failure (HF) often co-occur but the association between height and risk of HF in older adults has not been well studied. We have examined the association between height and incident AF and incident HF in older adults. Methods Prospective study of 3346 men aged 60–79 years with no diagnosed HF, myocardial infarction or stroke at baseline (1998–2000) followed up for a mean period of 16 years, in whom there were 294 incident HF cases and 456 incident AF. Men were divided into 5 height groups: <168.2, 168.2–172.5, 172.6–176.9, 177.0–183.0 and >183.0 cms based on the 25th, 50th, 75th and 95th centiles distribution of height. Results CVD risk factors tended to decrease with increasing height but a positive association was seen between height and electrocardiographic QRS duration and incident AF. Both short stature (<168.2 cm) and tall stature (>183.0 cm) was associated with significantly increased risk of HF in age-adjusted analysis compared to those in the second height quartile [HR (95 %CI) = 1.62 (1.15, 2.26) and 2.04 (1.23, 3.39) respectively]. In short men the increased risk remained after adjustment for adverse CVD risk factors; in tall men the association was largely associated with AF and QRS duration. Conclusion Tall stature is associated with significantly increased risk of AF leading to increased risk of HF. Short stature was associated with increased HF risk which was not explained by known adverse CVD risk factors.
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Key Words
- AF, atrial fibrillation
- Atrial fibrillation
- CHD, coronary heart disease
- CRP, C-reactive protein
- CVD, cardiovascular disease
- ECG, electrocardiogram
- Epidemiology
- FEV1, forced expiratory volume in 1 s
- HF, heart failure
- Heart failure
- Height
- LVH, left ventricular hypertrophy
- MI, myocardial infarction
- NT-proBNP, N-terminal pro-brain natriuretic peptide
- SBP, systolic blood pressure
- hsTnT, high sensitive troponin T
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Affiliation(s)
- S Goya Wannamethee
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Olia Papacosta
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Lucy Lennon
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Aroon Hingorani
- Institute of Cardiovascular Sciences, UCL, London, United Kingdom
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, United Kingdom
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6
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Ataklte F, Vasan RS. Heart failure risk estimation based on novel biomarkers. Expert Rev Mol Diagn 2021; 21:655-672. [PMID: 34014781 DOI: 10.1080/14737159.2021.1933446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Despite advances in medical care, heart failure (HF)-associated morbidity and mortality remains high. Consequently, there is increased effort to find better ways for predicting, screening, and prognosticating HF in order to facilitate effective primary and secondary prevention.Areas covered: In this review, we describe the various biomarkers associated with different etiologic pathways implicated in HF, and discuss their roles in screening, diagnosing, prognosticating and predicting HF. We explore the emerging role of multi-omic approaches. We performed electronic searches in databases (PubMed and Google Scholar) through December 2020, using the following key terms: biomarker, novel, heart failure, risk, prediction, and estimation.Circulating BNP and troponin concentrations have been established in clinical care as key biomarkers for diagnosing and prognosticating HF. Emerging biomarkers (such as galectin-3 and ST-2) have gained further recognition for use in evaluating prognosis of HF patients. Promising biomarkers that are yet to be part of clinical recommendations include biomarkers of cardiorenal disease.Expert opinion: Increasing recognition of the complex and interdependent nature of pathophysiological pathways of HF has led to the application of multi-marker approaches including multi-omic high throughput assays. These newer approaches have the potential for new therapeutic discoveries and improving precision medicine in HF.
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Affiliation(s)
- Feven Ataklte
- Department of Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Ramachandran S Vasan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Framingham, MA, USA.,Boston University Center for Computing and Data Sciences, Boston, MA, USA
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7
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McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Frailty and incident heart failure in older men: the British Regional Heart Study. Open Heart 2021; 8:openhrt-2021-001571. [PMID: 34088788 PMCID: PMC8183233 DOI: 10.1136/openhrt-2021-001571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/16/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Frailty and heart failure (HF) are cross-sectionally associated. Published longitudinal data are very limited. We sought to investigate associations between frailty and incident HF. METHODS Prospective study of 1722 men, examined at age 72-91 years. Scores based on the Fried phenotype, Gill index and a novel frailty score, based on the Health Ageing and Body Composition Battery, incorporating slow walking speed, low chair-stand time and subjective difficulty with balance, were calculated. Associations between these scores and incident HF were analysed with Cox proportional hazard modelling. RESULTS 1445 men with frailty data and without prevalent HF were included. 99 developed HF (mean follow-up 6.1 years). Men scoring 3/3 on our novel frailty score had elevated risk of incident HF (HR 2.77, 95% CI 1.25 to 6.15), which persisted after adjustment for established risk factors and interleukin-6 (HR 3.14, 95% CI 1.35 to 7.31). This risk remained increased, although attenuated, after excluding HF events within 2 years of baseline (HR 2.05, 95% CI 0.61 to 6.92). The frailty phenotype showed a non-significant association with HF (age-adjusted HR 1.92, 95% CI 0.99 to 3.73), which was further attenuated after adjustment for prevalent coronary heart disease and Body mass index (HR 1.60, 95% CI 0.81 to 3.15). Gill-type scores were weakly associated with HF risk after these adjustments (HR 1.31, 95% CI 0.47 to 3.70). CONCLUSION In these older men, the combination of slow walk speed, low sit-stand time and balance problems were associated with high risk of incident HF, independent of established risk factors and inflammatory markers. However, undiagnosed HF at baseline may still be a confounder. There is a differential association between aspects of the frailty phenotype and incident HF.
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Affiliation(s)
- Douglas GJ McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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Schill F, Timpka S, Nilsson PM, Melander O, Enhörning S. Copeptin as a predictive marker of incident heart failure. ESC Heart Fail 2021; 8:3180-3188. [PMID: 34056865 PMCID: PMC8318511 DOI: 10.1002/ehf2.13439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Heart failure (HF) is a common disease with increasing prevalence and poor prognosis. The vasopressin (VP) marker copeptin predicts development of diabetes mellitus, diabetic heart disease, coronary artery disease, and premature mortality. Copeptin is elevated in HF patients and predicts a worse outcome. This study aims to investigate whether copeptin can predict HF development. Methods Copeptin was analysed in 5297 individuals (69.6% men) without prevalent HF from the Malmö Preventive Project, a population‐based prospective cohort. Cox proportional hazards models were used to analyse risk of incident HF by copeptin levels after adjusting for conventional cardiovascular risk factors. Results During a median follow‐up time of 11.1 years, 350 subjects (6.6%) were diagnosed with HF. Of these events, 99 were classified as myocardial infarction (MI) related HF and 251 as non‐MI‐related HF. Individuals in the top quartile of copeptin had, after multivariate adjustment for conventional risk factors (age, sex, systolic blood pressure, diabetes mellitus, body mass index, antihypertensive therapy, smoking, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol), a significantly increased risk of developing HF by 1.63 [confidence interval (CI) 1.20–2.21] for HF compared with the reference quartile 1. After adjustment for conventional risk factors, the hazard ratio (HR) per standard deviation increase of log‐transformed copeptin for any HF was 1.30 (95% CI 1.17–1.46), whereas it was 1.39 (CI 1.13–1.71) for MI‐related HF and 1.26 (CI 1.11–1.44) for non‐MI‐related HF. The associations remained after additional adjustment for estimated glomerular filtration rate [HR 1.24 (95% CI: 1.10–1.40)] and for pro atrial natriuretic peptide on top of conventional risk factors [HR 1.14 (95% CI: 1.02–1.28)]. Conclusions Elevated copeptin predicts development of HF in older adults. Copeptin is a risk marker of VP‐driven HF susceptibility and a candidate to guide prevention efforts of HF targeting the VP system.
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Affiliation(s)
- Fredrika Schill
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Simon Timpka
- Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Sofia Enhörning
- Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Gilani A, De Caterina R, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG. Excessive Orthostatic Changes in Blood Pressure Are Associated With Incident Heart Failure in Older Men: A Prospective Analysis From the BRHS. Hypertension 2021; 77:1481-1489. [PMID: 33719509 DOI: 10.1161/hypertensionaha.120.15817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Artaza Gilani
- University College London Research Department of Primary Care and Population Health, Royal Free Hospital, United Kingdom (A.G., O.P., L.T.L., S.G.W.)
| | - Raffaele De Caterina
- Cardiovascular Division, Pisa University Hospital, University of Pisa, Italy (R.D.E.C.).,Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy (R.D.E.C.)
| | - Olia Papacosta
- University College London Research Department of Primary Care and Population Health, Royal Free Hospital, United Kingdom (A.G., O.P., L.T.L., S.G.W.)
| | - Lucy T Lennon
- University College London Research Department of Primary Care and Population Health, Royal Free Hospital, United Kingdom (A.G., O.P., L.T.L., S.G.W.)
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, United Kingdom (P.H.W.)
| | - S Goya Wannamethee
- University College London Research Department of Primary Care and Population Health, Royal Free Hospital, United Kingdom (A.G., O.P., L.T.L., S.G.W.)
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10
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McKechnie DG, Papacosta AO, Lennon LT, Welsh P, Whincup PH, Wannamethee SG. Inflammatory markers and incident heart failure in older men: the role of NT-proBNP. Biomark Med 2021; 15:413-425. [PMID: 33709785 PMCID: PMC8559131 DOI: 10.2217/bmm-2020-0669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: To determine the relationship between baseline inflammation (CRP and IL-6) with natriuretic peptide (NP) activity (measured by NT-proBNP) and incident heart failure (HF) in older men. Methods & results: In the British Regional Heart Study, 3569 men without prevalent myocardial infarction or HF were followed for mean 16.3 years; 327 developed HF. Baseline CRP and IL-6 were significantly and positively associated with NT-proBNP. Those in the highest CRP and IL-6 quartiles had an elevated risk of HF after age and BMI adjustment (HR = 1.42 [1.01–1.98] and 1.71 [1.24–2.37], respectively), which markedly attenuated after NT-proBNP adjustment (HR = 1.15 [0.81–1.63] and 1.25 [0.89–1.75], respectively). Conclusion: NP activity is associated with pro-inflammatory biomarkers and may explain the link between inflammation and incident HF. Inflammation describes the body’s natural response to infections, injuries and toxins. Inflammation is a helpful response in the short term, but it is thought that long-lasting inflammation – for example, due to illnesses such as diabetes or obesity – may have harmful effects. Previous studies have found that people with higher levels of inflammatory molecules in the blood seem to be more likely to develop heart failure (HF) later on. The amount of fluid in the body is controlled, in part, by molecules in the blood known as ‘natriuretic peptides' (NPs). People with HF have much higher levels of NPs in their blood, and these are used to help diagnose HF. There are suggestions that inflammation and natriuretic peptides are linked to one another. Using a sample of men aged 60–79 years, who did not have HF, we compared blood markers of inflammation and NPs at a baseline examination. Men with higher blood inflammatory markers tended to have higher blood NP levels. We then followed these men up for an average of 16.3 years. Men with higher blood inflammatory markers at baseline were more likely to develop HF, as expected, even after accounting for differences in age and BMI. However, when we accounted for NP levels at baseline, the increased risk of HF with inflammation disappeared. This suggests that NP activity is important in the relationship between inflammation and the risk of HF. Future studies should account for this when examining the link. It is possible that NPs or, more likely, whatever is driving their release, may explain why people with inflammation are more likely to get HF.
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Affiliation(s)
- Douglas Gj McKechnie
- Department of Primary Care & Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care & Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care & Population Health, University College London, London, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
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11
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Schrage B, Geelhoed B, Niiranen TJ, Gianfagna F, Vishram‐Nielsen JKK, Costanzo S, Söderberg S, Ojeda FM, Vartiainen E, Donati MB, Magnussen C, Di Castelnuovo A, Camen S, Kontto J, Koenig W, Blankenberg S, de Gaetano G, Linneberg A, Jørgensen T, Zeller T, Kuulasmaa K, Tunstall‐Pedoe H, Hughes M, Iacoviello L, Salomaa V, Schnabel RB. Comparison of Cardiovascular Risk Factors in European Population Cohorts for Predicting Atrial Fibrillation and Heart Failure, Their Subsequent Onset, and Death. J Am Heart Assoc 2020; 9:e015218. [PMID: 32351154 PMCID: PMC7428582 DOI: 10.1161/jaha.119.015218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Differences in risk factors for atrial fibrillation (AF) and heart failure (HF) are incompletely understood. Aim of this study was to understand whether risk factors and biomarkers show different associations with incident AF and HF and to investigate predictors of subsequent onset and mortality. Methods and Results In N=58 693 individuals free of AF/HF from 5 population‐based European cohorts, Cox regressions were used to find predictors for AF, HF, subsequent onset, and mortality. Differences between associations were estimated using bootstrapping. Median follow‐up time was 13.8 years, with a mortality of 15.7%. AF and HF occurred in 5.0% and 5.4% of the participants, respectively, with 1.8% showing subsequent onset. Age, male sex, myocardial infarction, body mass index, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) showed similar associations with both diseases. Antihypertensive medication and smoking were stronger predictors of HF than AF. Cholesterol, diabetes mellitus, and hsCRP (high‐sensitivity C‐reactive protein) were associated with HF, but not with AF. No variable was exclusively associated with AF. Population‐attributable risks were higher for HF (75.6%) than for AF (30.9%). Age, male sex, body mass index, diabetes mellitus, and NT‐proBNP were associated with subsequent onset, which was associated with the highest all‐cause mortality risk. Conclusions Common risk factors and biomarkers showed different associations with AF and HF, and explained a higher proportion of HF than AF risk. As the subsequent onset of both diseases was strongly associated with mortality, prevention needs to be rigorously addressed and remains challenging, as conventional risk factors explained only 31% of AF risk.
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Affiliation(s)
- Benedikt Schrage
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Bastiaan Geelhoed
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Teemu J. Niiranen
- Division of MedicineTurku University Hospital and University of TurkuTurkuFinland
- National Institute for Health and WelfareHelsinkiFinland
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly
- Mediterranea CardiocentroNapoliItaly
| | - Julie K. K. Vishram‐Nielsen
- Center for Cardiac, Vascular, Pulmonary and Infectious DiseasesRigshospitaletUniversity Hospital of CopenhagenDenmark
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Simona Costanzo
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilli (IS)Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart CentreUmeå UniversityUmeåSweden
| | - Francisco M. Ojeda
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | | | | | - Christina Magnussen
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | | | - Stephan Camen
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Jukka Kontto
- National Institute for Health and WelfareHelsinkiFinland
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität MünchenGermany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Institute of Epidemiology and Medical BiometryUniversity of UlmGermany
| | - Stefan Blankenberg
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | | | - Allan Linneberg
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenDenmark
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Torben Jørgensen
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Tanja Zeller
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Kari Kuulasmaa
- National Institute for Health and WelfareHelsinkiFinland
| | - Hugh Tunstall‐Pedoe
- Cardiovascular Epidemiology UnitInstitute of Cardiovascular ResearchUniversity of DundeeUnited Kingdom
| | - Maria Hughes
- Centre of Excellence for Public HealthQueen′s University Belfast,BelfastNorthern Ireland
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilli (IS)Italy
| | - Veikko Salomaa
- National Institute for Health and WelfareHelsinkiFinland
| | - Renate B. Schnabel
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
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12
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Zonoozi S, Ramsay SE, Papacosta O, Lennon LT, Ellins EA, Halcox JPJ, Whincup P, Wannamethee SG. Chronic kidney disease, cardiovascular risk markers and total mortality in older men: cystatin C versus creatinine. J Epidemiol Community Health 2019; 73:645-651. [DOI: 10.1136/jech-2018-211719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 11/04/2022]
Abstract
BackgroundIt remains uncertain whether cystatin C is a superior marker of renal function than creatinine in older adults. We have investigated the association between estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on creatinine (CKD-EPIcr) and cystatin C (CKD-EPIcys), and cardiovascular risk markers and mortality in older adults.MethodsThis is a cross-sectional and prospective study of 1639 British men aged 71–92 years followed up for an average of 5 years for mortality. Cox survival model and receiving operating characteristic analysis were used to assess the associations.ResultsThe prevalence of chronic kidney disease (CKD) was similar using the two CKD-EPI equations, although cystatin C reclassified 43.9% of those with stage 3a CKD (eGFR 45–59 mL/min/1.732, moderate damage) to no CKD. However, CKD stages assessed using both CKD-EPIcr and CKD-EPIcys were significantly associated with vascular risk markers and with all-cause and cardiovascular disease mortality. In all men with CKD (eGFR <60 mL/min/1.732), the HRs (95% CI) for all-cause mortality after adjustment for cardiovascular risk factors compared with those with no CKD were 1.53 (1.20 to 1.96) and 1.74 (1.35 to 2.23) using CKD-EPIcr and CKD-EPIcys, respectively. Comparisons of the two CKD equations showed no significant difference in their predictive ability for mortality (difference in area under the curve p=0.46).ConclusionDespite reclassification of CKD stages, assessment of CKD using CKD-EPIcys did not improve prediction of mortality in older British men >70 years. Our data do not support the routine use of CKD-EPIcys for identifying CKD in the elderly British male population.
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13
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Volpe M, Battistoni A, Rubattu S. Natriuretic peptides in heart failure: Current achievements and future perspectives. Int J Cardiol 2018; 281:186-189. [PMID: 30545616 DOI: 10.1016/j.ijcard.2018.04.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
Abstract
The last two centuries have witnessed countless discoveries in the field of medicine that found their roots in the up growing development of technology as well as in the visionary ideas of brilliant scientists and research groups. One of the most important discoveries in the field of cardiovascular medicine allowed to break the paradigm identifying the heart with mere mechanical pump and to characterize its intriguing endocrine properties. Indeed, the discovery of hormones produced by the cardiac chambers, the natriuretic peptides, represents one of the milestones of the current conception of complexity of integrated human physiology. In the last four decades, the role of these hormones in the regulation of the cardiovascular system, in physiology and diseases, has been defined piece after piece. From diagnostic and prognostic markers, natriuretic peptides have become one of the most relevant clinical biomarker and a reliable target for establishing the efficacy of therapies. Recently and successfully, natriuretic peptide-based strategies are proposed as therapeutic weapons to improve outcome in heart failure. The future will witness potential further therapeutic application of natriuretic peptides that are currently being actively investigated.
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Affiliation(s)
- Massimo Volpe
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
| | - Allegra Battistoni
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
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14
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Zhang ZL, Li R, Yang FY, Xi L. Natriuretic peptide family as diagnostic/prognostic biomarker and treatment modality in management of adult and geriatric patients with heart failure: remaining issues and challenges. J Geriatr Cardiol 2018; 15:540-546. [PMID: 30344534 PMCID: PMC6188938 DOI: 10.11909/j.issn.1671-5411.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/30/2022] Open
Abstract
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), the key members of natriuretic peptide family have been recommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure (HF) according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particularly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and challenges regarding the clinical utilization of BNP and NT-proBNP, which include: (1) Different prevalence and diagnostic/prognostic values of BNP isoforms; (2) methodological issues on detection of BNP; (3) glycosylation of proBNP and its effect on biomarker testing; (4) specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; (5) new development of natriuretic peptides as HF treatment modality; (6) BNP paradox in HF; and (7) special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.
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Affiliation(s)
- Zhen-Lu Zhang
- Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Ran Li
- Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Fei-Yan Yang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Xi
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
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15
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Serum magnesium and risk of incident heart failure in older men: The British Regional Heart Study. Eur J Epidemiol 2018; 33:873-882. [PMID: 29663176 PMCID: PMC6133024 DOI: 10.1007/s10654-018-0388-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/25/2018] [Indexed: 12/21/2022]
Abstract
To examine the association between serum magnesium and incident heart failure (HF) in older men and investigate potential pathways including cardiac function, inflammation and lung function. Prospective study of 3523 men aged 60–79 years with no prevalent HF or myocardial infarction followed up for a mean period of 15 years, during which 268 incident HF cases were ascertained. Serum magnesium was inversely associated with many CVD risk factors including prevalent atrial fibrillation, lung function (FEV1) and markers of inflammation (IL-6), endothelial dysfunction (vWF) and cardiac dysfunction [NT-proBNP and cardiac troponin T (cTnT)]. Serum magnesium was inversely related to risk of incident HF after adjustment for conventional CVD risk factors and incident MI. The adjusted hazard ratios (HRs) for HF in the 5 quintiles of magnesium groups were 1.00, 0.72 (0.50, 1.05), 0.85 (0.59, 1.26), 0.76 (0.52, 1.11) and 0.56 (0.36, 0.86) respectively [p (trend) = 0.04]. Further adjustment for atrial fibrillation, IL-6, vWF and FEV1 attenuated the association but risk remained significantly reduced in the top quintile (≥ 0.87 mmol/l) compared with the lowest quintile [HR 0.62 (0.40, 0.97)]. Adjustment for NT-proBNP and cTnT attenuated the association further [HR 0.70 (0.44, 1.10)]. The benefit of high serum magnesium on HF risk was most evident in men with ECG evidence of ischaemia [HR 0.29 (0.13, 0.68)]. The potential beneficial effect of high serum magnesium was partially explained by its favourable association with CVD risk factors. Further studies are needed to investigate whether serum magnesium supplementation in older adults may protect from the development of HF.
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16
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Parsons TJ, Sartini C, Welsh P, Sattar N, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH, Jefferis BJ. Objectively measured physical activity and cardiac biomarkers: A cross sectional population based study in older men. Int J Cardiol 2018; 254:322-327. [PMID: 29407114 PMCID: PMC5958950 DOI: 10.1016/j.ijcard.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-proBNP) and high sensitivity Troponin T (hsTnT) are markers of cardiac injury used in diagnosis of heart failure and myocardial infarction respectively, and associated with increased risk of cardiovascular disease. Since physical activity is protective against cardiovascular disease and heart failure, we investigated whether higher levels of physical activity, and less sedentary behaviour were associated with lower NT-proBNP and hsTnT. METHODS AND RESULTS Cross sectional study of 1130 men, age 70-91years, from the British Regional Heart Study, measured in 2010-2012. Fasting blood samples were analysed for NT-proBNP and hsTnT. Physical activity and sedentary behaviour were measured using ActiGraph GT3X accelerometers. Relationships between activity and NT-proBNP or hsTnT were non-linear; biomarker levels were lower with higher total activity, steps, moderate/vigorous activity and light activity only at low to moderate levels of activity. For example, for each additional 10min of moderate/vigorous activity, NT-proBNP was lower by 35.7% (95% CI -47.9, -23.6) and hsTnT by 8.4% (95% CI -11.1, -5.6), in men who undertook <25 or 50min of moderate/vigorous activity per day respectively. Biomarker levels increased linearly with increasing sedentary behaviour, but not independently of moderate/vigorous activity. CONCLUSION Associations between biomarkers and moderate/vigorous activity (and between hsTnT and light activity) were independent of sedentary behaviour, suggesting activity is driving the relationships. In these older men with concomitantly low levels of physical activity, activity may be more important in protecting against cardiac health deterioration in less active individuals, although reverse causality might be operating.
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Affiliation(s)
- Tessa J Parsons
- UCL Department of Primary Care & Population Health, United Kingdom.
| | - Claudio Sartini
- UCL Department of Primary Care & Population Health, United Kingdom
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, United Kingdom
| | - Sarah Ash
- UCL Department of Primary Care & Population Health, United Kingdom
| | - Lucy T Lennon
- UCL Department of Primary Care & Population Health, United Kingdom
| | | | - I-Min Lee
- Brigham and Women's Hospital, Harvard Medical School, United States
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, United Kingdom
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17
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Ibrahim NE, Lyass A, Gaggin HK, Liu Y, van Kimmenade RRJ, Motiwala SR, Kelly NP, Gandhi PU, Simon ML, Belcher AM, Harisiades JE, Massaro JM, D'Agostino RB, Januzzi JL. Predicting new-onset HF in patients undergoing coronary or peripheral angiography: results from the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study. ESC Heart Fail 2018; 5:240-248. [PMID: 29424480 PMCID: PMC5933950 DOI: 10.1002/ehf2.12268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/04/2017] [Accepted: 12/31/2017] [Indexed: 01/19/2023] Open
Abstract
Aims Methods to identify patients at risk for incident HF would be welcome as such patients might benefit from earlier interventions. Methods and results From a registry of 1251 patients referred for coronary and/or peripheral angiography, we sought to identify independent predictors of incident HF during follow‐up and develop a clinical and biomarker strategy to predict this outcome. There were 991 patients free of prevalent HF at baseline. Cox proportional hazard models were developed to predict adjudicated diagnosis of incident HF. Model discrimination and reclassification were evaluated. At follow‐up, 177 (18%) developed new‐onset HF. Independent predictors of new‐onset HF included five clinical variables (age, male sex, heart rate, history of atrial fibrillation/flutter, and history of hypertension) and two biomarkers (amino‐terminal pro‐B type natriuretic peptide and ST2). The c‐statistic for the model without biomarkers was 0.69; including biomarkers increased the c‐statistic to 0.76 (P < 0.001). A score was developed from the model. Patients in the highest score quintile had shortest time to incident HF compared with lower quintiles (log‐rank P < 0.001). Following 100 bootstrap iterations, internal validation was confirmed with Harrell's c‐statistic of 0.77. Use of angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, and beta‐blockers at enrollment was associated with substantial attenuation of predictive value of the risk score. Conclusions Patients undergoing coronary/peripheral angiographic procedures are a population at high risk for incident HF. We describe an accurate clinical and biomarker strategy for predicting incident HF and possibly intervening in such patients (NCT00842868).
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Affiliation(s)
- Nasrien E Ibrahim
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Asya Lyass
- Baim Institute for Clinical Research, Boston, MA, USA.,Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Hanna K Gaggin
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Yuyin Liu
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Roland R J van Kimmenade
- Cardiology Division, Radboud University Medical Center, Nijmegen, The Netherlands.,Cardiology Division, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Noreen P Kelly
- Cardiology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Parul U Gandhi
- Cardiology Division, VA Connecticut Healthcare System and Yale University, New Haven, CT, USA
| | - Mandy L Simon
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Arianna M Belcher
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph M Massaro
- Baim Institute for Clinical Research, Boston, MA, USA.,Department of Biostatistics, Boston University, Boston, MA, USA
| | - Ralph B D'Agostino
- Baim Institute for Clinical Research, Boston, MA, USA.,Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
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18
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Wannamethee SG, Jefferis BJ, Lennon L, Papacosta O, Whincup PH, Hingorani AD. Serum Conjugated Linoleic Acid and Risk of Incident Heart Failure in Older Men: The British Regional Heart Study. J Am Heart Assoc 2018; 7:e006653. [PMID: 29306896 PMCID: PMC5778956 DOI: 10.1161/jaha.117.006653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/21/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Evidence largely from animal studies suggests that conjugated linoleic acid (CLA) may have cardiovascular health benefits. However, few prospective studies have examined the association between CLA and cardiovascular disease. We have prospectively examined the association between serum CLA and incident coronary heart disease and heart failure (HF) in older men. METHODS AND RESULTS Prospective study of 3806 men, aged 60 to 79 years, without prevalent HF followed up for an average of 13 years, during which there were 295 incident HF cases. A high-throughput serum nuclear magnetic resonance metabolomics platform was used to measure CLA concentration in serum, expressed as a percentage of total fatty acids (CLA%). CLA% was adversely associated with cholesterol and high-density lipoprotein cholesterol but was inversely associated with C-reactive protein and NT-proBNP (N-terminal pro-B-type natriuretic peptide; a marker of ventricular stress). No association was seen between CLA% and incident coronary heart disease. High CLA% was associated with significantly reduced risk of HF after adjustment for HF risk factors and C-reactive protein (hazard ratio [95% confidence interval], 0.64 [0.43-0.96]; quartile 4 versus quartile 1). Elevated CLA% was associated with reduced HF risk only in those with higher dairy fat intake, a major dietary source of CLA (test for interaction P=0.03). The reduced risk of HF was partially explained by NT-proBNP. High dairy fat intake was not associated with incident coronary heart disease but was associated with reduced risk of HF, largely because of the inverse effect of CLA. CONCLUSIONS The finding that high CLA% is associated with lower risk of incident HF in older men requires confirmation in larger studies.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Barbara J Jefferis
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, United Kingdom
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, United Kingdom
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19
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Wannamethee SG, Papacosta O, Lennon L, Whincup PH. Serum uric acid as a potential marker for heart failure risk in men on antihypertensive treatment: The British Regional Heart Study. Int J Cardiol 2017; 252:187-192. [PMID: 29208425 PMCID: PMC5766825 DOI: 10.1016/j.ijcard.2017.11.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
The role of serum uric acid (SUA) as a prognostic marker for incident heart failure (HF) in hypertensive subjects is uncertain. We have prospectively examined the relationship between SUA and incident HF in 3440 men aged 60–79 years separately in those on and not on antihypertensive treatment who were followed up for a mean period of 15 years. Men on SUA lowering drugs and those with history of HF or myocardial infarction were excluded. There were 260 incident HF cases. The men were divided into three groups of SUA concentrations/levels (< 350, 350–410 and > 410 μmol/L). Raised SUA was associated with significantly increased risk of HF in men on antihypertensive treatment (N = 949) but not in those without (N = 2491) (p = 0.003 for interaction). In men on antihypertensive treatment those with hyperuricemia (> 410 μmol/L) had the most adverse biological risk profile for HF including the highest rates of atrial fibrillation and renal dysfunction and the highest mean level of BMI, c-reactive protein and cardiac function (cardiac troponin T). Treated hypertensive men with SUA levels > 410 μmol/L showed an increase in risk of HF of more than twofold compared to those on treatment with levels < 350 μmol/L even after adjustment for lifestyle characteristics and biological risk factors [adjusted hazard ratio 2.26 (1.23,4.15)]. SUA improved prediction of HF beyond routine conventional risk factors (p = 0.02 for improvement in c-statistics). SUA as a marker of increased xanthine oxidase activity may be a useful prognostic marker for HF risk in older men on antihypertensive treatment. Raised serum uric acid (SUA) is associated with increased risk of heart failure in older men on antihypertensive treatment Treated hypertensive men with raised SUA have the most adverse risk profile for heart failure including underlying ischaemia Monitoring of SUA in older hypertensive patients may identify high risk patients who would benefit from further investigation
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Affiliation(s)
- S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.
| | - Olia Papacosta
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Lucy Lennon
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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20
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Wannamethee SG, Welsh P, Papacosta O, Ellins EA, Halcox JPJ, Whincup PH, Sattar N. Circulating soluble receptor for advanced glycation end product: Cross-sectional associations with cardiac markers and subclinical vascular disease in older men with and without diabetes. Atherosclerosis 2017; 264:36-43. [PMID: 28759844 PMCID: PMC5603971 DOI: 10.1016/j.atherosclerosis.2017.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIMS The soluble receptor for advanced glycation end products (sRAGE) has been implicated in diabetic vascular complications. We have examined the association between sRAGE and cardiac markers [NT-proBNP and cardiac troponin T (cTnT)] and subclinical vascular markers in older men with and without diabetes. METHODS We performed a cross-sectional study of 1159 men aged 71-92 years with no history of cardiovascular disease (myocardial infarction, stroke, heart failure, coronary artery bypass graft operation or angioplasty). Prevalent diabetes included men with a doctor diagnosis of diabetes, men with fasting glucose ≥7 mmol/l or HbA1c ≥ 6.5% (N = 180). Subclinical vascular measurements included carotid intima media thickness (cIMT), arterial stiffness [pulse wave velocity (PWV)], central aortic blood pressure and arterial wave reflections [central augmentation pressure (AP) and augmentation index (AIx)]. RESULTS sRAGE was strongly and positively associated with renal dysfunction in men with and without diabetes. sRAGE was significantly and positively associated with NT-proBNP (but not cTnT) and AP and AIx in both groups of men after adjustment for CVD risk and metabolic risk markers, renal function and inflammation. However, no association was seen between sRAGE and central aortic blood pressure, cIMT or arterial stiffness as determined by PWV in either group. CONCLUSIONS Higher plasma sRAGE was associated with increased NT-proBNP and markers of arterial wave reflections in men both with and without diabetes. Increased sRAGE may contribute to or be a marker of worsening cardiac dysfunction or HF. Further studies with cardiac imaging data are required to confirm this.
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Affiliation(s)
- S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Olia Papacosta
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Elizabeth A Ellins
- Institute of Life Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Julian P J Halcox
- Institute of Life Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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21
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Zonoozi S, Ramsay SE, Papacosta O, Lennon L, Ellins EA, Halcox JPJ, Whincup PH, Goya Wannamethee S. Self-reported sleep duration and napping, cardiac risk factors and markers of subclinical vascular disease: cross-sectional study in older men. BMJ Open 2017; 7:e016396. [PMID: 28674146 PMCID: PMC5726087 DOI: 10.1136/bmjopen-2017-016396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDYOBJECTIVES Daytime sleep has been associated with increased risk of cardiovascular disease and heart failure (HF), but the mechanisms remain unclear. We have investigated the association between daytime and night-time sleep patterns and cardiovascular risk markers in older adults including cardiac markers and subclinical markers of atherosclerosis (arterial stiffness and carotid intima-media thickness (CIMT)). METHODS Cross-sectional study of 1722 surviving men aged 71-92 examined in 2010-2012 across 24 British towns from a prospective study initiated in 1978-1980. Participants completed a questionnaire and were invited for a physical examination. Men with a history of heart attack or HF (n=251) were excluded from the analysis. RESULTS Self-reported daytime sleep duration was associated with higher fasting glucose and insulin levels (p=0.02 and p=0.01, respectively) even after adjustment for age, body mass index, physical activity and social class. Compared with those with no daytime sleep, men with daytime sleep >1 hour, defined as excessive daytime sleepiness (EDS), had a higher risk of raised N-terminal pro-brain natriuretic peptide of ≥400 pg/mL, the diagnostic threshold for HF (OR (95% CI)=1.88 (1.15 to 3.1)), higher mean troponin, reduced lung function (forced expiratory volume in 1 s) and elevated von Willebrand factor, a marker of endothelial dysfunction. However, EDS was unrelated to CIMT and arterial stiffness. By contrast, night-time sleep was only associated with HbA1c (short or long sleep) and arterial stiffness (short sleep). CONCLUSIONS Daytime sleep duration of >1 hour may be an early indicator of HF.
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Affiliation(s)
- Shahrzad Zonoozi
- UCL Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Sheena E Ramsay
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Olia Papacosta
- UCL Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Lucy Lennon
- UCL Department of Primary Care and Population Health, UCL Medical School, London, UK
| | | | | | - Peter H Whincup
- Population Health Research Institute, St George’s University of London, London, UK
| | - S Goya Wannamethee
- UCL Department of Primary Care and Population Health, UCL Medical School, London, UK
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Chow SL, Maisel AS, Anand I, Bozkurt B, de Boer RA, Felker GM, Fonarow GC, Greenberg B, Januzzi JL, Kiernan MS, Liu PP, Wang TJ, Yancy CW, Zile MR. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e1054-e1091. [PMID: 28446515 DOI: 10.1161/cir.0000000000000490] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. METHODS The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. RESULTS A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. CONCLUSIONS HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.
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Risk Prediction Models for Incident Heart Failure: A Systematic Review of Methodology and Model Performance. J Card Fail 2017; 23:680-687. [PMID: 28336380 DOI: 10.1016/j.cardfail.2017.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/15/2017] [Accepted: 03/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Numerous models predicting the risk of incident heart failure (HF) have been developed; however, evidence of their methodological rigor and reporting remains unclear. This study critically appraises the methods underpinning incident HF risk prediction models. METHODS AND RESULTS EMBASE and PubMed were searched for articles published between 1990 and June 2016 that reported at least 1 multivariable model for prediction of HF. Model development information, including study design, variable coding, missing data, and predictor selection, was extracted. Nineteen studies reporting 40 risk prediction models were included. Existing models have acceptable discriminative ability (C-statistics > 0.70), although only 6 models were externally validated. Candidate variable selection was based on statistical significance from a univariate screening in 11 models, whereas it was unclear in 12 models. Continuous predictors were retained in 16 models, whereas it was unclear how continuous variables were handled in 16 models. Missing values were excluded in 19 of 23 models that reported missing data, and the number of events per variable was < 10 in 13 models. Only 2 models presented recommended regression equations. There was significant heterogeneity in discriminative ability of models with respect to age (P < .001) and sample size (P = .007). CONCLUSIONS There is an abundance of HF risk prediction models that had sufficient discriminative ability, although few are externally validated. Methods not recommended for the conduct and reporting of risk prediction modeling were frequently used, and resulting algorithms should be applied with caution.
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24
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Yan JJ, Lu Y, Kuai ZP, Yong YH. Predictive value of plasma copeptin level for the risk and mortality of heart failure: a meta-analysis. J Cell Mol Med 2017; 21:1815-1825. [PMID: 28244638 PMCID: PMC5571549 DOI: 10.1111/jcmm.13102] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022] Open
Abstract
Epidemiologic studies are inconsistent regarding the association between plasma copeptin level and heart failure (HF). The aim of this study was to perform a meta‐analysis to determine whether high level of copeptin is correlated with incidence of HF and mortality in patients with HF. We searched PUBMED and EMBASE databases for studies conducted from 1966 through May 2016 to identify studies reporting hazard ratio (HR) estimates with 95% confidence intervals (CIs) for the association between plasma copeptin level and HF. A random‐effects model was used to combine study‐specific risk estimates. A total of 13 studies were included in the meta‐analysis, with five studies on the incidence of HF and eight studies on the mortality of patients with HF. For incidence of HF, the summary HR indicated a borderline positive association of high plasma copeptin level with HF risk (HR, 1.60; 95% CI, 0.90–2.85). Furthermore, an increase of 1 standard deviation in log copeptin level was associated with a 17% increase in the risk of incident HF (HR, 1.17; 95% CI, 1.02–1.33). For all‐cause mortality of patients with HF, we also found a significant association between elevated plasma copeptin level and increased mortality of HF (HR, 1.76; 95% CI, 1.33–2.33). Our dose–response analysis indicated that an increment in copeptin level of 1 pmol/l was associated with a 3% increase in all‐cause mortality (HR, 1.03; 95% CI, 1.01–1.05). In conclusion, our results suggest that elevated plasma copeptin level is associated with an increased risk of HF and all‐cause mortality in patients with HF.
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Affiliation(s)
- Jian-Jun Yan
- Division of Cardiology, Jiangning Hospital Affiliated Nanjing Medical University, Nanjing, China
| | - Ying Lu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng-Ping Kuai
- Department of Cardiology, Shanghai Meishan Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Hong Yong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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25
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Karlström P, Johansson P, Dahlström U, Boman K, Alehagen U. The impact of time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. Results from the UPSTEP study. Int J Cardiol 2017; 236:315-320. [PMID: 28268084 DOI: 10.1016/j.ijcard.2017.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a life-threatening condition and optimal handling is necessary to reduce risk of therapy failure. The impact of the duration of HF diagnosis on HF outcome has not previously been examined. The objectives of this study were (I) to evaluate the impact of patient age on clinical outcomes, (II) to evaluate the impact of duration of the HF disease on outcomes, and (III) to evaluate the impact of age and HF duration on B-type Natriuretic Peptide (BNP) concentration in a population of HF patients. METHODS AND RESULTS In the UPSTEP (Use of PeptideS in Tailoring hEart failure Project) study we retrospectively evaluated how age and HF duration affected HF outcome. HF duration was divided into <1year, 1-5years and >5years. A multivariate Cox proportional hazard regression analysis showed that HF duration influenced outcome more than age, even when adjusted for comorbidities(<1year versus >5years: HR 1.65; 95% CI 1.28-2.14; P<0.0002) on HF mortality and hospitalisations. The influence of age on BNP showed increased BNP as age increased. However, there was a significant effect on BNP concentration when comparing HF duration of less than one year to HF duration to more than five years, even when adjusted for age. CONCLUSIONS Patients with longer HF duration had significantly worse outcome compared to those with short HF duration, even when adjusted for patient age and comorbidities. Age did not influence outcome but had an impact on BNP concentration; however, BNP concentration increased as HF duration increased.
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Affiliation(s)
- Patric Karlström
- Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
| | - Peter Johansson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kurt Boman
- Research unit Skellefteå Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Urban Alehagen
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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26
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Sahle BW, Owen AJ, Wing LMH, Nelson MR, Jennings GLR, Reid CM. Prediction of 10-year Risk of Incident Heart Failure in Elderly Hypertensive Population: The ANBP2 Study. Am J Hypertens 2017; 30:88-94. [PMID: 27638847 DOI: 10.1093/ajh/hpw119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Multivariable risk prediction models consisting of routinely collected measurements can facilitate early detection and slowing of disease progression through pharmacological and nonpharmacological risk factor modifications. This study aims to develop a multivariable risk prediction model for predicting 10-year risk of incident heart failure diagnosis in elderly hypertensive population. METHODS The derivation cohort included 6083 participants aged 65 to 84 years at baseline (1995-2001) followed for a median of 10.8 years during and following the Second Australian National Blood Pressure Study (ANBP2). Cox proportional hazards models were used to develop the risk prediction models. Variables were selected using bootstrap resampling method, and Akaike and Bayesian Information Criterion and C-statistics were used to select the parsimonious model. The final model was internally validated using a bootstrapping, and its discrimination and calibration were assessed. RESULTS Incident heart failure was diagnosed in 319 (5.2%) participants. The final multivariable model included age, male sex, obesity (body mass index > 30kg/m2), pre-existing cardiovascular disease, average visit-to-visit systolic blood pressure variation, current or past smoking. The model has C-statistics of 0.719 (95% CI: 0.705-0.748) in the derivation cohort, and 0.716 (95% CI: 0.701-0.731) after internal validation (optimism corrected). The goodness-of-fit test showed the model has good overall calibration (χ 2 = 1.78, P = 0.94). CONCLUSION The risk equation, consisting of variables readily accessible in primary and community care settings, allows reliable prediction of 10-year incident heart failure in elderly hypertensive population. Its application for the prediction of heart failure needs to be studied in the community setting to determine its utility for improving patient management and disease prevention.
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Affiliation(s)
- Berhe W Sahle
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Alice J Owen
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lindon M H Wing
- School of Medicine, Flinders University, Adelaide, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;
- School of Public Health, Curtin University, Perth, Australia
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27
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Wannamethee SG, Whincup PH, Papacosta O, Lennon L, Lowe GD. Associations between blood coagulation markers, NT-proBNP and risk of incident heart failure in older men: The British Regional Heart Study. Int J Cardiol 2016; 230:567-571. [PMID: 28043678 PMCID: PMC5267630 DOI: 10.1016/j.ijcard.2016.12.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
AIMS Chronic heart failure (HF) is associated with activation of blood coagulation but there is a lack of prospective studies on the association between coagulation markers and incident HF in general populations. We have examined the association between the coagulation markers fibrinogen, von Willebrand Factor (VWF), Factors VII, VIII and IX, D-dimer, activated protein C (APC) and activated partial thromboplastin time (aPPT) with NT-proBNP and incident HF. METHODS AND RESULTS Prospective study of 3366 men aged 60-79years with no prevalent HF, myocardial infarction or venous thrombosis and who were not on warfarin, followed up for a mean period of 13years, in whom there were 203 incident HF cases. D-dimer and vWF were significantly and positively associated with NT-proBNP (a marker of neurohormonal activation and left ventricular wall stress) even after adjustment for age, lifestyle characteristics, renal dysfunction, atrial fibrillation (AF) and inflammation (C-reactive protein). By contrast Factor VII related inversely to AF and NT-proBNP even after adjustment. No association was seen however between the coagulation markers VWF, Factor VII, Factor VIII, Factor IX, D-dimer, APC resistance or aPPT with incident HF in age-adjusted analyses. Fibrinogen was associated with incident HF but this was abolished after adjustment for HF risk factors. CONCLUSION Coagulation activity is not associated with the development of HF. However D-dimer and vWF were significantly associated with NT-proBNP, suggesting that increased coagulation activity is related to cardiac stress; and the increased coagulation seen in HF patients may in part be a consequence of neurohormonal activation.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, UK.
| | - Peter H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, UK
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College London, UK
| | - Gordon D Lowe
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, UK
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Farmakis D, Parissis J, Papingiotis G, Lekakis J, Filippatos G. Natriuretic peptides revisited. J Cardiovasc Med (Hagerstown) 2016; 17:840-2. [DOI: 10.2459/jcm.0000000000000447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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29
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Metra M, Carubelli V, Ravera A, Stewart Coats AJ. Heart failure 2016: still more questions than answers. Int J Cardiol 2016; 227:766-777. [PMID: 27838123 DOI: 10.1016/j.ijcard.2016.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Heart failure has reached epidemic proportions given the ageing of populations and is associated with high mortality and re-hospitalization rates. This article reviews and summarizes recent advances in the diagnosis, assessment and treatment of the patients with heart failure. Data are discussed based also on the most recent guidelines indications. Open issues and unmet needs are highlighted.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Alice Ravera
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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30
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Wannamethee SG, Welsh P, Lennon L, Papacosta O, Whincup PH, Sattar N. Copeptin and the risk of incident stroke, CHD and cardiovascular mortality in older men with and without diabetes: The British Regional Heart Study. Diabetologia 2016; 59:1904-12. [PMID: 27312697 PMCID: PMC4969339 DOI: 10.1007/s00125-016-4011-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/05/2016] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS This study aimed to examine the association between copeptin (a surrogate marker of arginine vasopressin) and incident stroke, CHD and cardiovascular mortality in older men with and without diabetes. METHODS We conducted a prospective study of 3536 men aged 60-79 years who were followed for an average of 13 years. During this period, there were 437 major CHD events (fatal and non-fatal myocardial infarction [MI]), 323 stroke events (fatal and non-fatal) and 497 cardiovascular disease (CVD) deaths. Prevalent diabetes was defined on the basis of a history of doctor-diagnosed diabetes or fasting blood glucose ≥7.0 mmol or HbA1c ≥6.5% (48 mmol/mol) (n = 428). RESULTS No association was seen between copeptin and incident stroke or CVD mortality in men without diabetes after adjustment for conventional cardiovascular risk factors, renal dysfunction, and insulin and N-terminal pro B-type natriuretic peptide levels. In contrast, elevated copeptin levels were associated with an increased risk of stroke and CVD mortality in men with diabetes after these adjustments. Compared with those in the lowest tertile of copeptin, men in the top tertile had adjusted relative HRs for stroke and CVD death of 2.34 (95% CI 1.04, 5.27) and 2.21 (1.12, 4.36), respectively. The risk of stroke and CVD mortality remained increased after the exclusion of men with prevalent stroke or MI. Higher levels of copeptin were associated with increased risk of CHD in the diabetic and non-diabetic groups, but these associations were attenuated after exclusion of individuals with a previous stroke or MI. CONCLUSIONS/INTERPRETATION Copeptin was independently associated with an increased risk of incident stroke and CVD mortality in men with diabetes, but not in men without diabetes. Targeting the arginine vasopressin system might have beneficial effects on CVD mortality and stroke risk in older men with diabetes.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lucy Lennon
- Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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31
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Wannamethee SG, Papacosta O, Lennon L, Whincup PH. Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study. J Am Geriatr Soc 2016; 64:1845-50. [PMID: 27351127 PMCID: PMC5031211 DOI: 10.1111/jgs.14255] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives To examine the associations between self‐reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). Design Population‐based prospective study. Setting General practices in 24 British towns. Participants Men aged 60–79 without prevalent HF followed for 9 years (N = 3,723). Measurements Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self‐reported sleep duration at night and daytime napping. Results Self‐reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self‐reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06–2.71) than in those who reported no daytime napping. Self‐reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31–6.45; 6 hours: aHR = 1.89, 95% CI = 0.89–4.03; 8 hours: aHR = 1.29, 95% CI = 0.61–2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71–4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk. Conclusion Self‐reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self‐reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College, London, United Kingdom.
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College, London, United Kingdom
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College, London, United Kingdom
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, United Kingdom
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Ho JE, Enserro D, Brouwers FP, Kizer JR, Shah SJ, Psaty BM, Bartz TM, Santhanakrishnan R, Lee DS, Chan C, Liu K, Blaha MJ, Hillege HL, van der Harst P, van Gilst WH, Kop WJ, Gansevoort RT, Vasan RS, Gardin JM, Levy D, Gottdiener JS, de Boer RA, Larson MG. Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes. Circ Heart Fail 2016; 9:e003116. [PMID: 27266854 PMCID: PMC4902276 DOI: 10.1161/circheartfailure.115.003116] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/12/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). METHODS AND RESULTS Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). CONCLUSIONS We describe and validate risk prediction models for HF subtypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.
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Affiliation(s)
| | | | | | | | - Sanjiv J. Shah
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Bruce M. Psaty
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Traci M. Bartz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Rajalakshmi Santhanakrishnan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Douglas S. Lee
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Cheeling Chan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Kiang Liu
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Michael J. Blaha
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Hans L. Hillege
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Pim van der Harst
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Wiek H. van Gilst
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Willem J. Kop
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ron T. Gansevoort
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ramachandran S. Vasan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Julius M. Gardin
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Daniel Levy
- Cardiovascular Research Center, Massachusetts General Hospital, Boston MA (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, Groningen, The Netherlands; Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Department of Biostatistics, University of Washington, Seattle, WA (T.M.B.); Institute for Clinical Evaluative Sciences, and University Health Network, University of Toronto, Toronto, Ontario, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
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Nilsson ED, Melander O, Elmståhl S, Lethagen E, Minthon L, Pihlsgård M, Nägga K. Copeptin, a Marker of Vasopressin, Predicts Vascular Dementia but not Alzheimer’s Disease. J Alzheimers Dis 2016; 52:1047-53. [DOI: 10.3233/jad-151118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erik D. Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Sweden
| | - Eva Lethagen
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Mats Pihlsgård
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
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Wannamethee SG, Shaper AG, Papacosta O, Lennon L, Welsh P, Whincup PH. Lung function and airway obstruction: associations with circulating markers of cardiac function and incident heart failure in older men-the British Regional Heart Study. Thorax 2016; 71:526-34. [PMID: 26811343 PMCID: PMC4893123 DOI: 10.1136/thoraxjnl-2014-206724] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/23/2015] [Indexed: 01/22/2023]
Abstract
Aims The association between lung function and cardiac markers and heart failure (HF) has been little studied in the general older population. We have examined the association between lung function and airway obstruction with cardiac markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) and risk of incident HF in older men. Methods and results Prospective study of 3242 men aged 60–79 years without prevalent HF or myocardial infarction followed up for an average period of 13 years, in whom 211 incident HF cases occurred. Incident HF was examined in relation to % predicted FEV1 and FVC. The Global Initiative on Obstructive Lung Diseases spirometry criteria were used to define airway obstruction. Reduced FEV1, but not FVC in the normal range, was significantly associated with increased risk of HF after adjustment for established HF risk factors including inflammation. The adjusted HRs comparing men in the 6–24th percentile with the highest quartile were 1.91 (1.24 to 2.94) and 1.30 (0.86 to 1.96) for FEV1 and FVC, respectively. FEV1 and FVC were inversely associated with NT-proBNP and cTnT, although the association between FEV1 and incident HF remained after adjustment for NT-proBNP and cTnT. Compared with normal subjects (FEV1/FVC ≥0.70 and FVC≥80%), moderate or severe (FEV1/FVC <0.70 and FEV1 <80%) airflow obstruction was independently associated with HF ((adjusted relative risk 1.59 (1.08 to 2.33)). Airflow restriction (FEV1/FVC ≥0.70 and FVC <80%) was not independently associated with HF. Conclusions Reduced FEV1 reflecting airflow obstruction is associated with cardiac dysfunction and increased risk of incident HF in older men.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Gerald Shaper
- Department of Primary Care and Population Health, University College London, London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Peter H Whincup
- Division of Population Health Sciences and Education, Population Health Research Centre, St George's University of London, London, UK
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Abstract
Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high despite therapeutic options. Medical management consists of a neurohormonal blockade of an overly activated neurohormonal axis. No single marker has been able to predict or monitor HF with respect to disease progression, hospitalization, or mortality. New methods for diagnosis, monitoring therapy, and prognosis are warranted. Copeptin, a precursor of pre-provasopressin, is a new biomarker in HF with promising potential. Copeptin has been found to be elevated in both acute and chronic HF and is associated with prognosis. Copeptin, in combination with other biomarkers, could be a useful marker in the monitoring of disease severity and as a predictor of prognosis and survival in HF.
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Affiliation(s)
- Louise Balling
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Wannamethee SG, Welsh P, Papacosta O, Lennon L, Whincup PH, Sattar N. Copeptin, Insulin Resistance, and Risk of Incident Diabetes in Older Men. J Clin Endocrinol Metab 2015; 100:3332-9. [PMID: 26158609 PMCID: PMC4570154 DOI: 10.1210/jc.2015-2362] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Prior studies suggested a role for the arginine vasopressin (AVP) system in the pathogenesis of diabetes. Prospective studies on the association between copeptin (the C-terminal fragment of AVP hormone) and incident diabetes are limited. OBJECTIVE We have examined the association between plasma copeptin and the risk of incident diabetes in older men. DESIGN The British Regional Heart Study was a prospective study with an average of 13 years follow-up. SETTING General practices in the United Kingdom were studied. PARTICIPANTS Participants were 3226 men aged 60 to 79 years with no prevalent diabetes. OUTCOME We measured 253 patients with incident diabetes. RESULTS Copeptin was positively and significantly associated with renal dysfunction, insulin resistance (homeostasis model assessment of insulin resistance), metabolic risk factors (waist circumference, blood pressure, triglycerides, and liver function), C-reactive protein, tissue plasminogen activator, and von Willebrand factor (endothelial dysfunction) but not with plasma glucose. The risk of incident diabetes was significantly elevated only in men in the top fifth of the copeptin distribution (>6.79 pmol/L), and this risk persisted after adjustment for several diabetes risk factors including metabolic risk factors and C-reactive protein (adjusted hazard ratio in the top fifth vs the rest = 1.78 [95% confidence interval, 1.34-2.37]). Risk was markedly attenuated although it remained significant after further adjustment for homeostasis model assessment of insulin resistance and plasma glucose (adjusted hazard ratio = 1.47 [1.11-1.97]). The increased risk was seen even when the analysis was restricted to men with no chronic kidney disease or to men with no impaired fasting glucose (<6.1 mmol/L). CONCLUSION Copeptin is associated with a significantly increased risk of diabetes in older men. The association is partly mediated through lower insulin sensitivity. The findings suggest a potential role of the AVP system in diabetes.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
| | - Paul Welsh
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
| | - Olia Papacosta
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
| | - Lucy Lennon
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
| | - Peter H Whincup
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
| | - Naveed Sattar
- Department of Primary Care and Population Health (S.G.W., O.P., L.L.), University College Medical School, Royal Free Campus, London NW3 2PF, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre (P.W., N.S.), Faculty of Medicine, University of Glasgow, G12 8TA Glasgow, United Kingdom; and Department of Community Health Sciences (P.H.W.), St George's, University of London SW17 ORE, London, United Kingdom
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Wannamethee SG, Whincup PH, Lennon L, Papacosta O, Shaper AG. Alcohol consumption and risk of incident heart failure in older men: a prospective cohort study. Open Heart 2015; 2:e000266. [PMID: 26290689 PMCID: PMC4536361 DOI: 10.1136/openhrt-2015-000266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 12/03/2022] Open
Abstract
Aims Light-to-moderate drinking has been associated with reduced risk of heart failure (HF). We have examined the association between alcohol consumption and incident HF in older British men. Methods and results Prospective study of 3530 men aged 60–79 years with no diagnosed HF or myocardial infarction (MI) at baseline and followed up for a mean period of 11 years, in whom there were 198 incident HF cases. Men were divided into 6 categories of alcohol consumption: none, <1, 1–6, 7–13, 14–34 and ≥35 drinks/week. There was no evidence that light-to-moderate drinking is beneficial for risk of HF. Heavy drinking (≥35 drinks/week) was associated with significantly increased risk of HF. Using the large group of men drinking 1–6 drinks/week as the reference group, the relative HRs (95% confidence interval) for HF adjusted for age, lifestyle characteristics, blood pressure, atrial fibrillation and renal dysfunction were 0.97 (0.59 to 1.63), 1.39 (0.86 to 2.25), 1.00, 0.94 (0.64 to 1.43), 1.16 (0.78 to 1.71) and 1.91 (1.02 to 3.56) for the 6 alcohol groups, respectively. The increased risk associated with heavy drinking was attenuated after adjustment for N-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=1.43 (0.76 to 1.69)). Stratified analysis showed heavy drinking was associated with increased HF risk only in those with ECG evidence of myocardial ischaemia. Conclusions There was no evidence that light-to-moderate drinking is beneficial for the prevention of HF in older men without a history of an MI. Heavier drinking (≥5 drinks/day), however, was associated with increased risk of HF in vulnerable men with underlying myocardial ischaemia.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health , University College London , London , UK
| | - Peter H Whincup
- Department of Population Health Sciences and Education , St George's, University of London , London , UK
| | - Lucy Lennon
- Department of Primary Care and Population Health , University College London , London , UK
| | - Olia Papacosta
- Department of Primary Care and Population Health , University College London , London , UK
| | - A Gerald Shaper
- Department of Primary Care and Population Health , University College London , London , UK
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Abstract
Increased neurohormonal activation is a key feature of heart failure (HF). Copeptin is a surrogate marker for proarginine vasopressin and the prognostic value of copeptin has been reported for multiple disease states of both nonvascular and cardiovascular etiology. Elevated plasma copeptin in HF has been associated with adverse outcomes such as increased mortality, risk of hospitalization and correlates with the severity of HF. Copeptin may add prognostic information to already established predictors such as clinical variables and natriuretic peptides in HF. In addition, copeptin has been found to be a superior marker when compared with BNP and NT-proBNP in HF patients discharged after hospitalization caused by HF or myocardial infarction (MI). The optimal use of copeptin in HF remains unresolved and future appropriately sized and randomized trials must determine the role of copeptin in HF as a marker of adverse outcomes, risk stratification or as a target in biomarker-guided therapy with arginine vasopressin-antagonists in individualized patient treatment and everyday clinical practice.
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Affiliation(s)
- Louise Balling
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Enhörning S, Hedblad B, Nilsson PM, Engström G, Melander O. Copeptin is an independent predictor of diabetic heart disease and death. Am Heart J 2015; 169:549-56.e1. [PMID: 25819862 PMCID: PMC4398501 DOI: 10.1016/j.ahj.2014.11.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/21/2014] [Indexed: 10/31/2022]
Abstract
BACKGROUND We previously discovered that high copeptin is associated with incidence of diabetes mellitus (diabetes), abdominal obesity, and albuminuria. Furthermore, copeptin predicts cardiovascular events after myocardial infarction in diabetic patients, but whether it is associated with heart disease and death in individuals without diabetes and prevalent cardiovascular disease is unknown. In this study, we aim to test whether plasma copeptin (copeptin), the C-terminal fragment of arginine vasopressin prohormone, predicts heart disease and death differentially in diabetic and nondiabetic individuals. METHODS We related plasma copeptin to a combined end point composed of coronary artery disease (CAD), heart failure (HF), and death in diabetes (n = 895) and nondiabetes (n = 4187) individuals of the Malmö Diet and Cancer Study-Cardiovascular cohort. RESULTS Copeptin significantly interacted with diabetes regarding the combined end point (P = .006). In diabetic individuals, copeptin predicted the combined end point (hazard ratio [HR] 1.32 per SD, 95% CI 1.10-1.58, P = .003) after adjustment for conventional risk factors, prevalent HF and CAD, and remained significant after additional adjustment for either fasting glucose (P = .02) or hemoglobin A1c (P = .02). Furthermore, in diabetic individuals, copeptin predicted CAD (HR 1.33 per SD, 95% CI 1.04-1.69, P = .02), HF (HR 1.62 per SD, 95% CI 1.09-2.41, P = .02), and death (HR 1.32 per SD, 95% CI 1.04-1.68, P = .02). Interestingly, among nondiabetic individuals, copeptin was not associated with any of the end points. CONCLUSIONS Copeptin predicted heart disease and death, specifically in diabetes patients, suggesting copeptin and the vasopressin system as a prognostic marker and therapeutic target for diabetic heart disease and death.
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Echouffo-Tcheugui JB, Greene SJ, Papadimitriou L, Zannad F, Yancy CW, Gheorghiade M, Butler J. Population risk prediction models for incident heart failure: a systematic review. Circ Heart Fail 2015; 8:438-47. [PMID: 25737496 DOI: 10.1161/circheartfailure.114.001896] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/27/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of heart failure is expected to significantly rise unless high-risk patients are effectively screened and appropriate, cost-effective prevention interventions are implemented. METHODS AND RESULTS We performed a systematic review to evaluate the prediction characteristics of the published heart failure risk prediction models as of August 2014 using MEDLINE and EMBASE databases. Eligible studies reported the development, validation, or impact assessment of a model. Two investigators performed independent review to extract data on study design and characteristics, risk predictors, discrimination, calibration, and reclassification ability of models, as well as validation and impact analysis. We included 13 publications reporting on 28 heart failure risk prediction models. Models had acceptable-to-good discriminatory ability (c-statistics, >0.70) in the derivation sample. Calibration was less commonly assessed, but was acceptable when it was. Only 2 models were externally validated more than once, displaying modest-to-acceptable discrimination (c-statistics, 0.61-0.79). When assessed, novel blood and imaging markers modestly improved risk prediction. One model assessed the prediction properties in race-based subgroups, whereas 2 models evaluated sex-based subgroups. Impact analysis found none of the models recommended for use in any clinical practice guideline. CONCLUSIONS Incident heart failure risk prediction remains at an early stage. The discrimination ability of current models is acceptable in derivation data sets but most models have not been externally validated. It remains unclear which models are cost-effective and best suit population screening needs. The effects of models on clinical and preventative care requires further study.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Stephen J Greene
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Lampros Papadimitriou
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Faiez Zannad
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Clyde W Yancy
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Mihai Gheorghiade
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.)
| | - Javed Butler
- From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
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Wannamethee SG, Welsh P, Papacosta O, Lennon L, Whincup PH, Sattar N. Elevated parathyroid hormone, but not vitamin D deficiency, is associated with increased risk of heart failure in older men with and without cardiovascular disease. Circ Heart Fail 2014; 7:732-9. [PMID: 25104043 DOI: 10.1161/circheartfailure.114.001272] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/28/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hyperparathyroidism and low vitamin D status have been implicated in the pathogenesis of heart failure (HF). We examined the prospective associations between parathyroid hormone (PTH), circulating 25-hydroxyvitamin D, and markers of mineral metabolism and risk of incident HF in older men with and without established cardiovascular disease. METHODS AND RESULTS Prospective study of 3731 men aged 60 to 79 years with no prevalent HF followed up for a mean period of 13 years, in whom there were 287 incident HF cases. Elevated PTH (≥55.6 pg/mL; top quarter) was associated with significantly higher risk of incident HF after adjustment for lifestyle characteristics, diabetes mellitus, blood lipids, blood pressure, lung function, heart rate, renal dysfunction, atrial fibrillation, forced expiratory volume in 1 second, and C-reactive protein (hazards ratio, 1.66; 95% confidence interval, 1.30-2.13). The increased risk was seen in both men with and without previous myocardial infarction or stroke (hazards ratio, 1.72; 95% confidence interval, 1.07-2.76; hazards ratio, 1.70; 95% confidence interval, 1.25-2.30, respectively). Elevated PTH was significantly associated with N-terminal probrain natriuretic peptide, a marker of left ventricular wall stress. By contrast, 25-hydroxyvitamin D and other markers of mineral metabolism including serum calcium and phosphate showed no significant association with incident HF after adjustment for age. CONCLUSIONS Elevated PTH, but not 25-hydroxyvitamin D or other markers of mineral metabolism, is associated with increased risk of HF in both older men with and without myocardial infarction/stroke. This increased risk was not explained by its association with known risk factors for HF. Further studies are now needed to elucidate the mechanisms underlying this association.
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Affiliation(s)
- S Goya Wannamethee
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
| | - Paul Welsh
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Olia Papacosta
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Lucy Lennon
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Peter H Whincup
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Naveed Sattar
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
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Wang H, Liu J, Zhao H, Zhou Y, Zhao X, Song Y, Li L, Shi H. Relationship between cardio-ankle vascular index and N-terminal pro-brain natriuretic peptide in hypertension and coronary heart disease subjects. ACTA ACUST UNITED AC 2014; 8:637-43. [DOI: 10.1016/j.jash.2014.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
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Madamanchi C, Alhosaini H, Sumida A, Runge MS. Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure. Int J Cardiol 2014; 176:611-7. [PMID: 25156856 DOI: 10.1016/j.ijcard.2014.08.007] [Citation(s) in RCA: 213] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/04/2014] [Accepted: 08/02/2014] [Indexed: 01/06/2023]
Abstract
Many advances have been made in the diagnosis and management of heart failure (HF) in recent years. Cardiac biomarkers are an essential tool for clinicians: point of care B-type natriuretic peptide (BNP) and its N-terminal counterpart (NT-proBNP) levels help distinguish cardiac from non-cardiac causes of dyspnea and are also useful in the prognosis and monitoring of the efficacy of therapy. One of the major limitations of HF biomarkers is in obese patients where the relationship between BNP and NT-proBNP levels and myocardial stiffness is complex. Recent data suggest an inverse relationship between BNP and NT-proBNP levels and body mass index. Given the ever-increasing prevalence of obesity world-wide, it is important to understand the benefits and limitations of HF biomarkers in this population. This review will explore the biology, physiology, and pathophysiology of these peptides and the cardiac endocrine paradox in HF. We also examine the clinical evidence, mechanisms, and plausible biological explanations for the discord between BNP levels and HF in obese patients.
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Affiliation(s)
| | | | - Arihiro Sumida
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Marschall S Runge
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA.
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Wijsman LW, Sabayan B, van Vliet P, Trompet S, de Ruijter W, Poortvliet RKE, van Peet PG, Gussekloo J, Jukema JW, Stott DJ, Sattar N, Ford I, Westendorp RGJ, de Craen AJM, Mooijaart SP. N-terminal pro-brain natriuretic peptide and cognitive decline in older adults at high cardiovascular risk. Ann Neurol 2014; 76:213-22. [DOI: 10.1002/ana.24203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Liselotte W. Wijsman
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Netherlands Consortium for Healthy Ageing; Leiden the Netherlands
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Department of Radiology; Leiden University Medical Center; Leiden the Netherlands
| | - Peter van Vliet
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Department of Neurology; Leiden University Medical Center; Leiden the Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Department of Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden the Netherlands
| | | | - Petra G. van Peet
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden the Netherlands
| | - J. Wouter Jukema
- Department of Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - David J. Stott
- Academic Section of Geriatric Medicine, Faculty of Medicine, University of Glasgow; Glasgow United Kingdom
| | - Naveed Sattar
- British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow; Glasgow United Kingdom
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow; Glasgow United Kingdom
| | | | - Anton J. M. de Craen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Netherlands Consortium for Healthy Ageing; Leiden the Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden the Netherlands
- Netherlands Consortium for Healthy Ageing; Leiden the Netherlands
- Institute for Evidence-Based Medicine in Old Age; Leiden the Netherlands
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The obesity paradox in men with coronary heart disease and heart failure: the role of muscle mass and leptin. Int J Cardiol 2013; 171:49-55. [PMID: 24331120 PMCID: PMC3909461 DOI: 10.1016/j.ijcard.2013.11.043] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/13/2013] [Accepted: 11/17/2013] [Indexed: 12/14/2022]
Abstract
AIMS We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. BACKGROUND The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). METHODS Prospective study of 4046 men aged 60-79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. RESULTS Overweight (BMI 25-9.9 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) were associated with lower mortality risk compared to men with normal weight (BMI 18.5-24.9 kg/m(2)) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p=0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p=0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p=0.60 for trend) but made minor differences to those with HF [p=0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p=0.98 for trend]. CONCLUSION The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.
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