期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 76, 期 12, 页码 1455-1465出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2020.07.044
关键词
biomarkers; heart failure; predictive value; risk factors; sex differences
资金
- National Heart, Lung, and Blood Institute [HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080]
- National Center for Advancing Translational Sciences (NCATS) [UL1-TR000040, UL1-TR-001079, UL1-TR-001420]
- National Institutes of Health [R01 HL107577, R01 HL127028, R01 HL140731, R01 HL149423, R01 HL128914, 2R01 HL092577]
- American Heart Association [16SFRN28780016, 18SFRN34110082]
- National Institute on Aging [R01AG023629]
- Dutch Kidney Foundation [E.013]
- Netherlands Heart Foundation (CVON SHE-PREDICTS-HF) [2017-21]
- Netherlands Heart Foundation (CVON-DOSIS) [2014-040]
- Netherlands Heart Foundation (CVON RED-CVD) [2017-11]
- Netherlands Heart Foundation (CVON PREDICT2) [2018-30]
- European Research Council [ERC CoG 818715]
- ZollLifeCor
- Johnson Johnson
- Ted Rogers Chair in Heart Function Outcomes
- AstraZeneca
- Abbott
- Bristol-Myers Squibb
- Novartis
- Novo Nordisk
- Roche
- Amgen
- U.S. Food and Drug Administration
- Singulex
- Sphingotec
- Roche Diagnostics
- National Institutes of Health/National Heart, Lung, and Blood Institute
- Actelion
- Corvia
- Pfizer
- Gilead Sciences
- Bayer
- EcoNugenics
- [HHSN268201500001I]
- [N01-HC 25195]
- [K23-HL138260]
- [R01 HL134893]
- [R01 HL140224]
- [N01HC85081]
- [N01HC85082]
- [N01HC85083]
- [N01HC85086]
- [U01HL080295]
- [U01HL130114]
- [N01-HC25195]
- [75N92020D00001]
- [HHSN268201500003I]
- [N01-HC-95159]
- [75N92020D00005]
- [N01-HC-95160]
- [75N92020D00002]
- [N01-HC-95161]
- [75N92020D00003]
- [N01HC-95162]
- [75N92020D00006]
- [N01-HC-95163]
- [75N92020D00004]
- [N01-HC-95164]
- [75N92020D00007]
- [N01-HC-95165]
- [N01-HC-95166]
- [N01-HC-95167]
- [N01-HC-95168]
- [N01-HC-95169]
BACKGROUND Whether cardiovascular (CV) disease risk factors and biomarkers associate differentially with heart failure (HF) risk in men and women is unclear. OBJECTIVES The purpose of this study was to evaluate sex-specific associations of CV risk factors and biomarkers with incident HF. METHODS The analysis was performed using data from 4 community-based cohorts with 12.5 years of follow-up. Participants (recruited between 1989 and 2002) were free of HF at baseline. Biomarker measurements included natriuretic peptides, cardiac troponins, plasminogen activator inhibitor-1, D-dimer, fibrinogen, C-reactive protein, sST2, galectin-3, cystatin-C, and urinary albumin-to-creatinine ratio. RESULTS Among 22,756 participants (mean age 60 +/- 13 years, 53% women), HF occurred in 2,095 participants (47% women). Age, smoking, type 2 diabetes mellitus, hypertension, body mass index, atrial fibrillation, myocardial infarction, left ventricular hypertrophy, and left bundle branch block were strongly associated with HF in both sexes (p < 0.001), and the combined clinical model had good discrimination in men (C-statistic = 0.80) and in women (C-statistic = 0.83). The majority of biomarkers were strongly and similarly associated with HF in both sexes. The clinical model improved modestly after adding natriuretic peptides in men (SC-statistic = 0.006; likelihood ratio chi-square = 146; p < 0.001), and after adding cardiac troponins in women (Delta C-statistic = 0.003; likelihood ratio chi-square 73; p < 0.001). CONCLUSIONS CV risk factors are strongly and similarly associated with incident HF in both sexes, highlighting the similar importance of risk factor control in reducing HF risk in the community. There are subtle sex-related differences in the predictive value of individual biomarkers, but the overall improvement in HF risk estimation when included in a clinical HF risk prediction model is limited in both sexes. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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