title: Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]).
abstract: The prevalence of pedal edema (PE) and its associations with abnormal cardiac structure/function, natriuretic peptides, and incident heart failure (HF) is unknown, especially in community-dwelling adults without a history of cardiovascular disease.
  
  
  
  Out of 5004 MESA (Multiethnic Study of Atherosclerosis) participants who had cardiac magnetic resonance imaging, 4196 had complete data and were included in this analysis (3501 for the right ventricle analysis). Logistic regression and Cox proportional hazard analyses were used to assess the associations among self-reported PE, 2-pillow orthopnea, paroxysmal nocturnal dyspnea, left and right ventricular structure and function, natriuretic peptide levels, and incident HF. PE was present in 28% of the participants. PE was not associated with overt left or right ventricular systolic dysfunction (ejection fraction <50%). PE was associated with 2-pillow orthopnea (odds ratio 1.66; 95% confidence interval [CI], 1.30-2.12), paroxysmal nocturnal dyspnea (odds ratio 1.95; 95% CI, 1.55-2.44), and abnormal N-terminal pro-B-type natriuretic peptide levels (defined as >400 pg/mL; odds ratio 1.80; 95% CI, 1.21-2.68) in adjusted models. After a mean of 10.2 years of follow-up, 184/4196 (4.4%) participants had an adjudicated incident HF hospitalization. PE was associated with incident HF hospitalization in models adjusted for age, sex, and race (hazard ratio 1.44; 95% CI, 1.05-1.97). This association persisted after adding additional covariates, including comorbidities, baseline left ventricular ejection fraction, and antecedent myocardial infarction (hazard ratio 1.43; 95% CI, 1.02-1.99). The association of PE with incident HF was attenuated by further adjustment for N-terminal pro-B-type natriuretic peptide.
  
  
  
  PE is prevalent in community-dwelling adults without clinically recognized cardiovascular disease and associated with future hospitalized HF.
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). jyeboah@wakehealth.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Waqas
authors.initials: W
authors.lastname: Qureshi
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Shivani
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Nadine
authors.initials: N
authors.lastname: Kawel-Boehm
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood / Q000150:complications* / Q000208:ethnology; D015331:Cohort Studies; D004489:Edema, Cardiac / Q000097:blood / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D016016:Proportional Hazards Models; D057566:Self Report
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: cardiac structure and function; heart failure; natriuretic peptides; orthopnea; paroxysmal nocturnal dyspnea; pedal edema