title: Absolute and attributable risks of heart failure incidence in relation to optimal risk factors.
abstract: BACKGROUND
  Epidemiological studies have shown that a large proportion of coronary heart disease and stroke events are explained by borderline or elevated risk factors and that adults with optimal risk factors greatly avoid these events. The degree to which this applies to heart failure incidence is not well documented.
  
  
  RESULTS
  We categorized baseline (1987-1989) risk factors in the Atherosclerosis Risk in Communities Study cohort (n=13,460, aged 45 to 64 years) into optimal, borderline, and elevated groups based on national guidelines, using a 4-factor score (blood pressure, plasma cholesterol, diabetes, and smoking) and a 5-factor score (which included body mass). Incidence of hospitalized heart failure (n=1344) was identified over a 16-year period. Only 4.9% of the cohort at baseline had all optimal risk factors based on the 4-factor score and 2.6% using the 5-factor score. Compared with participants with any elevated risk factor using the 4-factor score, the age-, sex-, and race-adjusted relative hazard for heart failure events was 0.18 (95% CI, 0.10 to 0.32) for those with all optimal risk factors and 0.35 (95% CI, 0.30 to 0.41) for those with only borderline risk factors. A population-attributable fraction estimate suggested that having at least 1 of the 4 risk factors, elevated or borderline, accounted for 77.1% of heart failure events. For the 5-factor score, that percentage was 88.8%.
  
  
  CONCLUSIONS
  Middle-aged adults with optimal (low) risk factors have low incidence rates of heart failure, which supports redoubled efforts to prevent risk factor development in the first place.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minn 55454, USA. folso001@umn.edu
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology