Abstract
BackgroundHeart failure (HF) represents an accumulated burden of systemic vascular damage and is the fastest growing form of cardiovascular disease (CVD). Due to increasing HF-attributable mortality rates, we sought to assess the association of the new 2019 Pooled Cohort equations to Prevent Heart Failure (PCP-HF) risk score with CVD and all-cause mortality.MethodsWe linked data for 6333 black and white men and women aged 40–79 years, whom underwent electrocardiographic examination from the Third National Health and Nutrition Exam Survey, to National Death Index record matches. Sex- and race-specific PCP-HF risk scores were calculated using data on age, smoking, body mass index, systolic blood pressure, total cholesterol, HDL-cholesterol, fasting blood glucose, QRS complex duration, and antihypertensive and/or glucose-lowering medications. Cox regression estimated hazard ratios for the association of the PCP-HF risk score with CVD and all-cause mortality.ResultsIndividuals were on average 54.9 years old (51.7% women, 25.4% black) and the median 10-year HF risk was 1.6% (Q1 = 0.5, Q3 = 4.8). There were 3178 deaths, 1116 from CVD, over a median follow-up time of 22.3 years. Black women had a higher 10-year HF risk compared to white women (2.1% vs. 1.1%; p < 0.01), while no significant difference was observed in predicted HF risk between black men and white men (2.3% vs. 2.1%, p = 0.16). A two-fold higher PCP-HF risk score was associated with a significant 58% (HR = 1.58; 95% CI, 1.48–1.70; p < 0.0001) and 38% (HR = 1.38; 95% CI, 1.32–1.46; p < 0.0001) greater risk of CVD and all-cause mortality, respectively.ConclusionThe PCP-HF risk score predicts CVD and all-cause mortality, in addition to the 10-year risk of incident HF among white and black men and women. These results underline the expanded utility of the PCP-HF risk score and suggest that its implementation in the clinical and population health settings may improve primary CVD prevention in the United States.
Highlights
Heart failure (HF) represents an accumulated burden of systemic vascular damage and is the fastest growing form of cardiovascular disease (CVD)
We found that the 10-year risk for incident HF varied according to social determinants of health, and groups with the highest HF risk included those with an annual household income below the poverty line, those living alone, as well as black participants
Given that myocardial infarction is the primary cause of HF worldwide [29], and CVD remains the leading cause of death globally, it is likely that poverty and environmental factors, collectively known as social determinants of health, influence the risk for incident HF
Summary
Heart failure (HF) represents an accumulated burden of systemic vascular damage and is the fastest growing form of cardiovascular disease (CVD). Due to increasing HF-attributable mortality rates, we sought to assess the association of the new 2019 Pooled Cohort equations to Prevent Heart Failure (PCP-HF) risk score with CVD and all-cause mortality. Heart failure (HF) is the fastest growing form of cardiovascular disease (CVD) nationally and globally, as its prevalence is projected to increase by 46% over the decade in the United States [1,2,3]. In an effort to improve HF risk stratification and prevention, the Pooled Cohort equations to Prevent HF (PCP-HF) risk score was developed and validated in 2019 using combined individual-level data from five diverse population-based cohorts to estimate the 10-year risk for incident HF [8]. Though a variety of HF risk scores exist [9,10,11,12], the PCP-HF contains parameters that are obtained in a primary care setting, and was developed with information from younger adults as well black men and women, in contrast to current risk prediction tools
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