title: Relations of lipid concentrations to heart failure incidence: the Framingham Heart Study.
abstract: BACKGROUND
  The relations of lipid concentrations to heart failure (HF) risk have not been elucidated comprehensively.
  
  
  RESULTS
  In 6860 Framingham Heart Study participants (mean age, 44 years; 54% women) free of baseline coronary heart disease, we related high-density lipoprotein cholesterol (HDL-C) and non-HDL-C to HF incidence during long-term follow-up, adjusting for clinical covariates and myocardial infarction at baseline and updating these at follow-up examinations. We evaluated dyslipidemia-specific population burden of HF by calculating population attributable risks. During follow-up (mean of 26 years), 680 participants (49% women) developed HF. Unadjusted HF incidence in the low (<160 mg/dL) versus high (> or =190 mg/dL) non-HDL-C groups was 7.9% and 13.8%, respectively, whereas incidence in the high (> or =55 [men], > or =65 [women] mg/dL) versus low (<40 [men], <50 [women] mg/dL) HDL-C groups was 6.1% and 12.8%, respectively. In multivariable models, baseline non-HDL-C and HDL-C, modeled as continuous measures, carried HF hazards (confidence intervals) of 1.19 (1.11 to 1.27) and 0.82 (0.75 to 0.90), respectively, per SD increment. In models updating lipid concentrations every 8 years, the corresponding hazards (confidence intervals) were 1.23 (1.16 to 1.31) and 0.77 (0.70 to 0.85). Participants with high baseline non-HDL-C and those with low HDL-C experienced a 29% and 40% higher HF risk, respectively, compared with those in the desirable categories; the population attributable risks for high non-HDL-C and low HDL-C were 7.5% and 15%, respectively. Hazards associated with non-HDL-C and HDL-C remained statistically significant after additional adjustment for interim myocardial infarction.
  
  
  CONCLUSIONS
  Dyslipidemia carries HF risk independent of its association with myocardial infarction, suggesting that lipid modification may be a means for reducing HF risk.
authors.affiliation: Framingham Heart Study, Center for Population Studies, National Heart, Lung, and Blood Institute, 73 Mt Wayte Avenue, Framingham, MA 01702, USA.
authors.forename: Raghava S
authors.initials: RS
authors.lastname: Velagaleti
authors.forename: Joseph
authors.initials: J
authors.lastname: Massaro
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Sander J
authors.initials: SJ
authors.lastname: Robins
authors.forename: William B
authors.initials: WB
authors.lastname: Kannel
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
mesh_terms: D000328:Adult; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids