Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study
Background Whether coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Methods and Results Among 9902 participants in the ARIC (Atherosclerosis Risk in Communities) study, we assessed the association of incident CAD w...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021660 |
| _version_ | 1811261001946890240 |
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| author | Jenine E. John Brian Claggett Hicham Skali Scott D. Solomon Jonathan W. Cunningham Kunihiro Matsushita Suma H. Konety Dalane W. Kitzman Thomas H. Mosley Donald Clark Patricia P. Chang Amil M. Shah |
| author_facet | Jenine E. John Brian Claggett Hicham Skali Scott D. Solomon Jonathan W. Cunningham Kunihiro Matsushita Suma H. Konety Dalane W. Kitzman Thomas H. Mosley Donald Clark Patricia P. Chang Amil M. Shah |
| author_sort | Jenine E. John |
| collection | DOAJ |
| description | Background Whether coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Methods and Results Among 9902 participants in the ARIC (Atherosclerosis Risk in Communities) study, we assessed the association of incident CAD with subsequent incident HFpEF (left ventricular ejection fraction [≥50%]) and HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction <50%) using survival models with time‐updated variables. We also assessed the extent to which echocardiographic correlates of prevalent CAD account for the relationship between CAD and incident HFpEF. Over 13‐year follow‐up, incident CAD developed in 892 participants and 178 subsequently developed HF (86 HFrEF, 71 HFpEF). Incident HFrEF and HFpEF risk were both greatest early after the CAD event. At >1 year post‐CAD event, adjusted incidence of HFrEF and HFpEF were similar (7.2 [95% CI, 5.2–10.0] and 6.7 [4.8–9.2] per 1000 person‐years, respectively) and CAD remained predictive of both (HFrEF: hazard ratio, 2.76 [95% CI, 1.99–3.84]; HFpEF: 1.85 [1.35–2.54]) after adjusting for demographics and common comorbidities. Among 4779 HF‐free participants at Visit 5 (2011–2013), the 490 with prevalent CAD had lower left ventricular ejection fraction and higher left ventricular mass index, E/e’, and left atrial volume index (all P<0.01). The association of prevalent CAD with incident HFpEF post‐Visit 5 was not significant after adjusting for echocardiographic measures, with the greatest attenuation observed for left ventricular diastolic function. Conclusions CAD is a significant risk factor for incident HFpEF after adjustment for demographics and common comorbidities. This relationship is partially accounted for by echocardiographic alterations, particularly left ventricular diastolic function. |
| first_indexed | 2024-04-12T18:56:00Z |
| format | Article |
| id | doaj.art-aea25ac3a855477895c94c0dcd50af2d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T18:56:00Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-aea25ac3a855477895c94c0dcd50af2d2022-12-22T03:20:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-09-01111710.1161/JAHA.121.021660Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC StudyJenine E. John0Brian Claggett1Hicham Skali2Scott D. Solomon3Jonathan W. Cunningham4Kunihiro Matsushita5Suma H. Konety6Dalane W. Kitzman7Thomas H. Mosley8Donald Clark9Patricia P. Chang10Amil M. Shah11Noninvasive Cardiovascular Imaging Program Departments of Medicine and Radiology Brigham and Women’s Hospital Boston MACardiovascular Division Brigham and Women’s Hospital Boston MANoninvasive Cardiovascular Imaging Program Departments of Medicine and Radiology Brigham and Women’s Hospital Boston MACardiovascular Division Brigham and Women’s Hospital Boston MANoninvasive Cardiovascular Imaging Program Departments of Medicine and Radiology Brigham and Women’s Hospital Boston MAJohns Hopkins Bloomberg School of Public Health Baltimore MDDivision of Cardiovascular Medicine University of Minnesota Minneapolis MNCardiovascular Medicine Section Wake Forest School of Medicine Winston‐Salem NCDepartment of Medicine University of Mississippi Medical Center Jackson MSDivision of Cardiology University of Mississippi Medical Center Jackson MSDivision of Cardiology University of North Carolina at Chapel Hill Chapel Hill NCCardiovascular Division Brigham and Women’s Hospital Boston MABackground Whether coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Methods and Results Among 9902 participants in the ARIC (Atherosclerosis Risk in Communities) study, we assessed the association of incident CAD with subsequent incident HFpEF (left ventricular ejection fraction [≥50%]) and HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction <50%) using survival models with time‐updated variables. We also assessed the extent to which echocardiographic correlates of prevalent CAD account for the relationship between CAD and incident HFpEF. Over 13‐year follow‐up, incident CAD developed in 892 participants and 178 subsequently developed HF (86 HFrEF, 71 HFpEF). Incident HFrEF and HFpEF risk were both greatest early after the CAD event. At >1 year post‐CAD event, adjusted incidence of HFrEF and HFpEF were similar (7.2 [95% CI, 5.2–10.0] and 6.7 [4.8–9.2] per 1000 person‐years, respectively) and CAD remained predictive of both (HFrEF: hazard ratio, 2.76 [95% CI, 1.99–3.84]; HFpEF: 1.85 [1.35–2.54]) after adjusting for demographics and common comorbidities. Among 4779 HF‐free participants at Visit 5 (2011–2013), the 490 with prevalent CAD had lower left ventricular ejection fraction and higher left ventricular mass index, E/e’, and left atrial volume index (all P<0.01). The association of prevalent CAD with incident HFpEF post‐Visit 5 was not significant after adjusting for echocardiographic measures, with the greatest attenuation observed for left ventricular diastolic function. Conclusions CAD is a significant risk factor for incident HFpEF after adjustment for demographics and common comorbidities. This relationship is partially accounted for by echocardiographic alterations, particularly left ventricular diastolic function.https://www.ahajournals.org/doi/10.1161/JAHA.121.021660atherosclerosiscoronary artery diseasediastolic functionechocardiographyheart failure with preserved ejection fraction |
| spellingShingle | Jenine E. John Brian Claggett Hicham Skali Scott D. Solomon Jonathan W. Cunningham Kunihiro Matsushita Suma H. Konety Dalane W. Kitzman Thomas H. Mosley Donald Clark Patricia P. Chang Amil M. Shah Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atherosclerosis coronary artery disease diastolic function echocardiography heart failure with preserved ejection fraction |
| title | Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study |
| title_full | Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study |
| title_fullStr | Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study |
| title_full_unstemmed | Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study |
| title_short | Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study |
| title_sort | coronary artery disease and heart failure with preserved ejection fraction the aric study |
| topic | atherosclerosis coronary artery disease diastolic function echocardiography heart failure with preserved ejection fraction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021660 |
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