title: Arterial Stiffness and Risk of Overall Heart Failure, Heart Failure With Preserved Ejection Fraction, and Heart Failure With Reduced Ejection Fraction: The Health ABC Study (Health, Aging, and Body Composition).
abstract: Higher arterial stiffness is associated with increased risk of atherosclerotic events. However, its contribution toward risk of heart failure (HF) and its subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), independent of other risk factors is not well established. In this study, we included Health ABC study (Health, Aging, and Body Composition) participants without prevalent HF who had arterial stiffness measured as carotid-femoral pulse wave velocity (cf-PWV) at baseline (n=2290). Adjusted Cox-proportional hazards models were constructed to determine the association between continuous and data-derived categorical measures (tertiles) of cf-PWV and incidence of HF and its subtypes (HFpEF [ejection fraction >45%] and HFrEF [ejection fraction ≤45%]). We observed 390 HF events (162 HFpEF and 145 HFrEF events) over 11.4 years of follow-up. In adjusted analysis, higher cf-PWV was associated with greater risk of HF after adjustment for age, sex, ethnicity, mean arterial pressure, and heart rate (hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref] =1.35 [1.05-1.73]). However, this association was not significant after additional adjustment for other cardiovascular risk factors (hazard ratio [95% confidence interval], 1.14 [0.88-1.47]). cf-PWV velocity was also not associated with risk of HFpEF and HFrEF after adjustment for potential confounders (most adjusted hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref]: HFpEF, 1.06 [0.72-1.56]; HFrEF, 1.28 [0.83-1.97]). In conclusion, arterial stiffness, as measured by cf-PWV, is not independently associated with risk of HF or its subtypes after adjustment for traditional cardiovascular risk factors.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.).
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (A.P., J.D.B.) and Department of Clinical Sciences (J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Department of Epidemiology, Graduate School of Public Health at University of Pittsburgh, PA (A.B.N.); Laboratory of Cardiovascular Science, Biomedical Research Center, National Institutes of Heath, National Institute of Aging, Baltimore, MD (E.G.L.); Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, PA (D.E.F.); and Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, NY (J.B.). jarett.berry@utsouthwestern.edu.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
mesh_terms: D000368:Aged; D000375:Aging; D001823:Body Composition; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D014481:United States / Q000453:epidemiology; D059289:Vascular Stiffness / Q000502:physiology*
keywords: arterial stiffness; ejection fraction; heart failure; hypertension; pulse wave velocity