Heart failure risk prediction in the Multi-Ethnic Study of Atherosclerosis.
OBJECTIVE
Heart failure (HF) is a leading cause of mortality especially in older populations. Early detection of high-risk individuals is imperative for primary prevention. The purpose of this study was to develop a HF risk model from a population without clinical cardiac disease.


METHODS
The Multi-Ethnic Study of Atherosclerosis is a multicentre observational cohort study following 6814 subjects (mean age 62±10 years; 47% men) who were free of clinical cardiovascular disease at baseline. Median follow-up was 4.7 years. HF events developed in 176 participants. Cox proportional hazards models and regression coefficients were used to determine independent risk factors and generate a 5-year risk score for incident HF. Bootstrapping with bias correction was used for internal validation.


RESULTS
Independent predictors for HF (HR, p value) were age (1.30 (1.10 to 1.50) per 10 years), male gender (2.27 (1.53 to 3.36)), current smoking (1.97 (1.15 to 3.36)), body mass index (1.40 (1.10 to 1.80) per 5 kg/m(2)), systolic blood pressure (1.10 (1.00 to 1.10) per 10 mm Hg), heart rate (1.30) (1.10 to 1.40) per 10 bpm), diabetes (2.27 (1.48 to 3.47)), N-terminal pro-B-type natriuretic peptide (NT proBNP) (2.48 (2.16 to 2.84) per unit log increment) and left ventricular mass index (1.40 (1.30 to 1.40) per 10 g/m(2)). A parsimonious model based on age, gender, body mass index, smoking status, systolic blood pressure, heart rate, diabetes and NT proBNP natriuretic peptide predicted incident HF risk with a c-statistic of 0.87.


CONCLUSIONS
A clinical algorithm based on risk factors readily available in the primary care setting can used to identify individuals with high likelihood of developing HF without pre-existing cardiac disease.
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
Harjit
H
Chahal
Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.
David A
DA
Bluemke
Offices of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, Maryland, USA.
Colin O
CO
Wu
Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Washington, USA.
Robyn
R
McClelland
Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Kiang
K
Liu
Department of Epidemiology, Columbia University, New York, New York, USA.
Steven J
SJ
Shea
Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, USA.
Gregory
G
Burke
Department of Cardiology, Wake Forest University, Winston-Salem, North Carolina, USA.
Pelbreton
P
Balfour
Department of Cardiology, Wake Forest University, Winston-Salem, North Carolina, USA.
David
D
Herrington
Offices of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, Maryland, USA.
PeiBei
P
Shi
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
Wendy
W
Post
Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Jean
J
Olson
Division of Cardiology, UCLA-School of Medicine, Los Angeles, California, USA.
Karol E
KE
Watson
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
Aaron R
AR
Folsom
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
Joao A C
JA
Lima
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001213:Asian; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology*; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People
HEART FAILURE