Affiliation:
1. Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY USA
2. Department of Biostatistics Mailman School of Public Health Columbia University New York NY USA
3. Center for American Indian Health Research, Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK USA
4. Cardiovascular Health Research Unit, Department of Epidemiology University of Washington Seattle WA USA
5. Department of Cardiology Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Clinic Floridsdorf Vienna Austria
6. Cardiology Department Hospital Universitario Virgen de la Victoria, IBIMA‐BIONAND, University of Malaga Malaga Spain
7. Ciber‐Cardiovascular Instituto de Salud Carlos III Madrid Spain
8. Medicine and Dematology Department University of Malaga Malaga Spain
9. MedStar Health Research Institute Hyattsville MD USA
10. Georgetown‐Howard Universities Center for Clinical and Translational Science Washington DC USA
11. Population Health Program Texas Biomedical Research Institute San Antonio TX USA
12. Department of Medicine Columbia University Irving Medical Center New York NY USA
13. Department of Medicine Weill Cornell Medicine New York NY USA
Abstract
Background
Despite the high burden of diabetes and cardiovascular risk factors in American Indian communities in the United States, prospective studies of heart failure (HF) in this population group are scarce, and the generalizability of previous HF risk scales may be limited. We developed a parsimonious HF risk prediction equation that accounts for relevant risk factors affecting American Indian communities, focusing on diabetes and kidney damage.
Methods and Results
A total of 3059 participants from the SHS (Strong Heart Study) (56±8 years of age, 58% women) were included. Five hundred seven developed HF. Progressively adjusted Cox proportional hazards models were used to identify risk factors for HF and HF subtypes. Predictors of risk at 5 and 10 years included older age (hazard ratio [HR], 1.79 [95% CI, 1.43–2.25]; HR, 1.68 [95% CI, 1.44–1.95]), smoking (HR, 2.26 [95% CI, 1.23–4.13]; HR, 2.08 [95% CI, 1.41–3.06]), macroalbuminuria (HR, 8.38 [95% CI, 4.44–15.83]; HR, 5.20 [95% CI, 3.42–7.9]), microalbuminuria (HR, 2.72 [95% CI, 1.51–4.90]; HR, 1.92 [95% CI, 1.33, 2.78]), and previous myocardial infarction (HR, 6.58 [95% CI, 2.54–17.03]; HR, 3.87 [95% CI, 2.29–6.54]), respectively. These predictors, together with diabetes diagnosis and glycated hemoglobin were significant at 10 and 28 years. High discrimination performance was achieved (C index, 0.81 [95% CI, 0.76–0.84]; C index, 0.78 [95% CI, 0.75–0.81]; and C index, 0.77 [95% CI, 0.74–0.78] at 5, 10, and up to 28 years of follow up, respectively). Some associations varied across HF subtypes, although diabetes, albuminuria, and previous myocardial infarction were associated with all subtypes.
Conclusions
This prospective study of HF risk factors in American Indian communities identifies that smoking, body mass index, and indicators of diabetes control and kidney damage (glycated hemoglobin and albuminuria) are major determinants of HF. Our findings can improve HF risk assessment in populations with a high burden of diabetes.
Publisher
Ovid Technologies (Wolters Kluwer Health)