Aferdita Spahillari1, Sameera Talegawkar1, Adolfo Correa1, J Jeffrey Carr1, James G Terry1, João Lima1, Jane E Freedman1, Saumya Das1, Robb Kociol1, Sarah de Ferranti1, Donya Mohebali1, Stanford Mwasongwe1, Katherine L Tucker1, Venkatesh L Murthy2, Ravi V Shah2. 1. From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.). 2. From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.). rvshah@partners.org vlmurthy@med.umich.edu.
Abstract
BACKGROUND: The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States. METHODS AND RESULTS: We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance. CONCLUSIONS: Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
BACKGROUND: The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States. METHODS AND RESULTS: We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance. CONCLUSIONS: Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
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