title: Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors.
abstract: BACKGROUND
  Studies from Sweden have reported association between immigrant status and incidence of cardiovascular diseases. The nature of this relationship is unclear. We investigated the relationship between immigrant status and risk of heart failure (HF) hospitalization in a population-based cohort, and to what extent this is mediated by hypertension and life-style risk factors. We also explored whether immigrant status was related to case-fatality after HF.
  
  
  METHODS
  26,559 subjects without history of myocardial infarction (MI), stroke or HF from the community-based Malmö Diet and Cancer (MDC) cohort underwent a baseline examination during 1991-1996. Incidence of HF hospitalizations was monitored during a mean follow-up of 15 years.
  
  
  RESULTS
  3,129 (11.8%) subjects were born outside Sweden. During follow-up, 764 subjects were hospitalized with HF as primary diagnosis, of whom 166 had an MI before or concurrent with the HF. After adjustment for potential confounding factors, the hazard ratios (HR) for foreign-born were 1.37 (95% CI: 1.08-1.73, p = 0.009) compared to native Swedes, for HF without previous MI. The results were similar in a secondary analysis without censoring at incident MI. There was a significant interaction (p < 0.001) between immigrant status and waist circumference (WC), and the increased HF risk was limited to immigrants with high WC. Although not significant foreign-born tended to have lower one-month and one-year mortality after HF.
  
  
  CONCLUSIONS
  Immigrant status was associated with long-term risk of HF hospitalization, independently of hypertension and several life-style risk factors. A significant interaction between WC and immigrant status on incident HF was observed.
authors.affiliation: Department of Clinical Sciences, Cardiovascular Epidemiology, Skåne University Hospital, Lund University, Malmö, Sweden. Yan.Borne@med.lu.se
authors.forename: Yan
authors.initials: Y
authors.lastname: Borné
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essén
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors