Predictors of heart failure among women with coronary disease.
BACKGROUND
Although heart failure is common among women with coronary disease, the risk factors for developing heart failure have not been well studied. We determined the risk factors for developing heart failure among postmenopausal women with established coronary disease.


RESULTS
This is a prospective cohort study using data from the Heart and Estrogen/progestin Replacement Study (HERS), a randomized, blinded, placebo-controlled trial of 4.1 years' duration, and subsequent open-label observational follow-up for 2.7 years (HERS II), performed at 20 US clinical centers between 1993 and 2000. Of the 2763 postmenopausal women with established coronary disease in the HERS trial, we studied the 2391 women with no heart failure at baseline by self-report and physical examination. The primary outcome of this analysis was incident heart failure defined by hospital admission or death from heart failure. During the 6.3+/-1.4-year follow-up, 237 women (10%) developed heart failure. Nine predictors were identified: diabetes (defined as a self-reported history of diabetes on treatment), atrial fibrillation, myocardial infarction, creatinine clearance <40 mL/min, systolic blood pressure >120 mm Hg, current smoking, body mass index >35 kg/m2, left bundle-branch block, and left ventricular hypertrophy. Randomization to estrogen/progestin was not associated with heart failure (hazard ratio=1.0; 95% CI, 0.7 to 1.3). Diabetes was the strongest risk factor (adjusted hazard ratio=3.1; 95% CI, 2.3 to 4.2). Diabetic women with elevated body mass index or depressed creatinine clearance were at highest risk, with annual incidence rates of 7% and 13%, respectively. Among diabetic women, hyperglycemia was associated with heart failure risk (adjusted hazard ratio=3.0; 95% CI, 1.2 to 7.5 for fasting glucose >300 mg/dL compared with fasting glucose 80 to 150 mg/dL).


CONCLUSIONS
We identified 9 predictors of heart failure in postmenopausal women with coronary disease. Diabetes was the strongest risk factor, particularly when poorly controlled or with concomitant renal insufficiency or obesity.
Bibbins-Domingo
Kirsten
K
Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA 94143-1364, USA. bibbinsk@medicine.ucsf.edu
Lin
Feng
F
Vittinghoff
Eric
E
Barrett-Connor
Elizabeth
E
Hulley
Stephen B
SB
Grady
Deborah
D
Shlipak
Michael G
MG
D001741:Black or African American; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D002037:Bundle-Branch Block / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D020249:Hormone Replacement Therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017698:Postmenopause; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate