Sarah O Nomura1, Amy B Karger2, Natalie L Weir3, Joao A C Lima4, George Thanassoulis5, Michael Y Tsai6. 1. Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Minneapolis 55455 MN, USA. Electronic address: oppe0020@umn.edu. 2. Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Minneapolis 55455 MN, USA. Electronic address: karge026@umn.edu. 3. Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Minneapolis 55455 MN, USA. Electronic address: weirx065@umn.edu. 4. Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street Blalock 524, Baltimore 21287 MD, USA. Electronic address: jlima@jhmi.edu. 5. Preventive and Genomic Cardiology, Divisions of Cardiology and Clinical Epidemiology, McGill University Health Center and Research Institute, 1001 Decarie Boulevard, Montreal,H4A 3J1 Quebec, Canada. Electronic address: George.thanassoulis@mcgill.ca. 6. Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Minneapolis 55455 MN, USA. Electronic address: tsaix001@umn.edu.
Abstract
BACKGROUND: Free fatty acids (FFAs) may be associated with heart failure (HF) risk, but prospective research is lacking. OBJECTIVE: This study investigated associations between fasting FFAs and HF incidence overall and by ejection fraction (EF) subtypes [HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF)] to evaluate FFAs as a potential biomarker for HF risk prediction. METHODS: This study was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort among 6,667 participants with complete baseline (2000-2002) FFAs and HF follow-up (through 2015). Associations between FFAs and HF incidence were evaluated with Cox proportional hazards regression. Cross-sectional associations between FFAs and HF risk markers were also evaluated using linear regression [N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular (LV) mass index] and logistic regression [LV hypertrophy (LVH)]. Stratification and cross-product terms were utilized to evaluate differences by age, sex, race/ethnicity and diabetes. RESULTS: FFAs were not associated with HF overall or with HFrEF. FFAs were not associated with HFpEF in the overall population or among males, but were borderline positively associated with risk among females (fully-adjusted tertile 3 vs. 1 HR=2.17, 95% CI: 1.06, 4.42) (sex P-interaction=0.05). FFAs were not associated with NT-proBNP, but were inversely associated with LV mass index and LVH with stronger associations among females (P-interaction≥0.10). Associations did not differ by age, race/ethnicity or diabetes status. CONCLUSIONS: FFAs generally do not appear to be an independent predictor for HF risk. Additional research is needed to confirm findings particularly studies evaluating associations by sex and EF subtypes.
BACKGROUND: Free fatty acids (FFAs) may be associated with heart failure (HF) risk, but prospective research is lacking. OBJECTIVE: This study investigated associations between fasting FFAs and HF incidence overall and by ejection fraction (EF) subtypes [HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF)] to evaluate FFAs as a potential biomarker for HF risk prediction. METHODS: This study was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort among 6,667 participants with complete baseline (2000-2002) FFAs and HF follow-up (through 2015). Associations between FFAs and HF incidence were evaluated with Cox proportional hazards regression. Cross-sectional associations between FFAs and HF risk markers were also evaluated using linear regression [N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular (LV) mass index] and logistic regression [LV hypertrophy (LVH)]. Stratification and cross-product terms were utilized to evaluate differences by age, sex, race/ethnicity and diabetes. RESULTS: FFAs were not associated with HF overall or with HFrEF. FFAs were not associated with HFpEF in the overall population or among males, but were borderline positively associated with risk among females (fully-adjusted tertile 3 vs. 1 HR=2.17, 95% CI: 1.06, 4.42) (sex P-interaction=0.05). FFAs were not associated with NT-proBNP, but were inversely associated with LV mass index and LVH with stronger associations among females (P-interaction≥0.10). Associations did not differ by age, race/ethnicity or diabetes status. CONCLUSIONS: FFAs generally do not appear to be an independent predictor for HF risk. Additional research is needed to confirm findings particularly studies evaluating associations by sex and EF subtypes.
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