Abstract P511: Trajectories of Modifiable Risk Factors, Cardiac Function and Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Cohort

Abstract

Introduction: Modifiable risk factors are known to associate with incident heart failure (HF), however, their longitudinal impacts have not been fully understood. Independent trajectory clusters of risk factors can help provide insights to the development of HF. Hypothesis: We hypothesize that unfavorable trajectory clusters are associated with increasing risk of HF. Methods: Clinical risk factors, including body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein (LDL), heart rate, total cholesterol (TCH), and high-density lipoprotein (HDL) were measured in Atherosclerosis Risk in Communities (ARIC) study at 5 consecutive visits (1987-2013). Trajectories were built for each clinical risk factor in participants with at least 3 time points using group-based trajectory modeling approach. Controlling for clinical risk factors, trajectory groups and their associations with post visit 5 incident HF were assessed via Cox proportional regression. Sex stratified analyses were conducted to assess effect modification. Results: Among 4,548 participants (mean age 75, 18.1% Blacks), 390 developed HF after visit 5 (median follow = 8.4 years). Five distinct clusters were identified for SBP, LDL, TCH, heart rate, and three clusters for BMI and HDL. Compared to the lowest cluster, normal-fast rising SBP cluster (HR = 1.7, 95% CI 1.2, 2.5), severely obese BMI cluster (HR = 1.9, 95%CI 1.4, 2.6), and normal-fast rising heart rate cluster (HR = 1.7, 95%CI 1.1, 2.5) had higher risk of developing HF. Interestingly, suboptimal-stable LDL cluster (HR = 0.6, 95%CI 0.4, 0.8) was associated with lower risk of HF compared to the optimal-stable LDL cluster. When stratified by sex (female =59.1%, male = 40.9%), the identified trajectories shared similar patterns with the parent trajectories. The effects on HF were consistent between sex groups; however, most significant associations were diminished in males. Conclusion: We identified distinct trajectories that capture long-term effects of risk factors. Unfavorable clusters significantly associated with increased risk of HF, except LDL, suggesting further investigation on lipids control for HF prevention.