Risk factors for heart failure in patients with one prior myocardial infarction episode.
OBJECTIVE
Myocardial infarction is an important risk factor for HF, increasing risk 2- to 3-fold. Other identified classical risk factors for HF include left ventricular hypertrophy, valvular heart disease, hypertension, diabetes mellitus, cigarette smoking, obesity, and dyslipidaemia. New mechanisms, such as insulin resistance, inflammation, and oxidative stress, have been investigated, but the importance of many of these mechanisms is largely unexplored in patients of HF. Our aim was to evaluate the factors involved in heart failure installation in patients with prior myocardial infarction.


METHODS
We performed a cross-sectional study including 144 patients presenting old, certified myocardial infarction. Patients were divided into two groups according to presence/absence of heart failure, as certified by New York Heart Association (NYHA) classification of heart and of echocardiography criteria by left ventricular ejection fraction < 40%. Univariate and multivariate models were performed to identify the independent predictors of heart failure. Also, receiver operating characteristic analysis doubled by chi square test for trend was performed to analyze the risk impact of each identified predictor.


RESULTS
Univariate between groups comparison was significant for hypertension (p = 0.001), diabetes mellitus (p < 0.001), smoking status (p < 0.001), obesity (p = 0.027), waist circumference (p < 0.001), and levels of C-reactive protein (p < 0.001), total cholesterol (p = 0.008), triglycerides (p = 0.003), HDL-Cholesterol (p < 0.001), glycaemia (p < 0.001) and brain natriuretic peptide (p < 0.001). Multivariate analysis selected C-reactive protein (OR = 2.7, 95% CI = 1.9-4.9, p < 0.001), glycaemia (OR = 2.1, 95% CI = 1.2-4.5, p = 0.027) and HDL-Cholesterol (OR = 0.7, 95% CI = 0.3-0.9, p = 0.035) as independent predictors. Separate across quintile test for trend revealed that the highest risk is added by levels of C-reactive protein levels > = 24mg/dL, followed by glycaemia levels > = 114 mg/dL and HDL-Cholesterol < 32 mg/dL.


CONCLUSIONS
Reducing of C-reactive protein and glycaemia levels, as well as increasing the level of HDL-Cholesterol may add a great benefit in reducing heart failure installation risk in patients with myocardial infarction.
Department of Normal Morphology and Functions, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. teodora_mocan@yahoo.com
Teodora
T
Mocan
Lucia
L
Agoşton-Coldea
M
M
Gatfossé
Sophie
S
Rosenstingl
L C
LC
Mocan
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology*; D006801:Humans; D006943:Hyperglycemia; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications*; D016017:Odds Ratio; D012372:ROC Curve; D012307:Risk Factors
D008076:Cholesterol, HDL; D002097:C-Reactive Protein