@article {7357, title = {Association of Holter-Derived Heart Rate Variability Parameters With the Development of Congestive Heart Failure in the Cardiovascular Health Study.}, journal = {JACC Heart Fail}, year = {2017}, month = {2017 Mar 30}, abstract = {

OBJECTIVES: This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health~ABC) score.

BACKGROUND: Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF).

METHODS: Asymptomatic CHS participants with interpretable~24-h baseline Holter recordings were included (n~= 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n~= 260) and without (n~= 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression.

RESULTS: The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95\% confidence interval [CI]: 1.07 to 1.19; p~< 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR:~1.52; 95\% CI: 1.11 to 2.08; p~= 0.009), short-term fractal scaling exponent (aHR: 0.27; 95\% CI: 0.14 to 0.53; p~<~0.001), in very low frequency power (aHR: 1.28; 95\% CI: 1.02 to 1.60; p~= 0.037), and coefficient of variance of N-N~intervals (aHR: 0.94; 95\% CI: 0.90 to 0.99; p~= 0.009). The C-statistic for the final model was significantly improved~over the Health ABC model alone (0.77 vs. 0.73; p~= 0.0002).

CONCLUSIONS: Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score.

}, issn = {2213-1787}, doi = {10.1016/j.jchf.2016.12.015}, author = {Patel, Vaiibhav N and Pierce, Brian R and Bodapati, Rohan K and Brown, David L and Ives, Diane G and Stein, Phyllis K} } @article {7344, title = {Bone Mineral Density and Risk of Heart Failure in Older Adults: The Cardiovascular Health Study.}, journal = {J Am Heart Assoc}, volume = {6}, year = {2017}, month = {2017 Mar 13}, abstract = {

BACKGROUND: Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (BMD) and heart failure (HF) risk remains insufficiently studied.

METHODS AND RESULTS: We investigated whether BMD measured by dual-energy x-ray absorptiometry was associated with incident HF in an older cohort. Cox models were stratified by sex and interactions of BMD with race assessed. BMD was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55\% women) developed HF during the median follow-up of 10.5~years. In both black and nonblack women, neither total hip nor femoral neck BMD was significantly associated with HF; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck, BMD was significantly associated with HF, with evidence of an interaction by race. In nonblack men, lower total hip BMD was associated with higher HF risk (hazard ratio, 1.13 [95\% CI, 1.01-1.26] per 0.1~g/cm(2) decrement), whereas in black men, lower total hip BMD was associated with lower HF risk (hazard ratio, 0.74 [95\% CI, 0.59-0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher HF risk (hazard ratio, 2.83 [95\% CI, 1.39-5.74]) compared with normal BMD.

CONCLUSIONS: Among older adults, lower total hip BMD was associated with higher HF risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.

}, issn = {2047-9980}, doi = {10.1161/JAHA.116.004344}, author = {Fohtung, Raymond B and Brown, David L and Koh, William J H and Bartz, Traci M and Carbone, Laura D and Civitelli, Roberto and Stein, Phyllis K and Chaves, Paulo H M and Kestenbaum, Bryan R and Kizer, Jorge R} } @article {7983, title = {Association of Alcohol Consumption After Development of Heart Failure With Survival Among Older Adults in the Cardiovascular Health Study.}, journal = {JAMA Netw Open}, volume = {1}, year = {2018}, month = {2018 Dec 07}, pages = {e186383}, abstract = {

Importance: More than 1 million older adults develop heart failure annually. The association of alcohol consumption with survival among these individuals after diagnosis is unknown.

Objective: To determine whether alcohol use is associated with increased survival among older adults with incident heart failure.

Design, Setting, and Participants: This prospective cohort study included 5888 community-dwelling adults aged 65 years or older who were recruited to participate in the Cardiovascular Health Study between June 12, 1989, and June 1993, from 4 US sites. Of the total participants, 393 individuals had a new diagnosis of heart failure within the first 9 years of follow-up through June 2013. The study analysis was performed between January 19, 2016, and September 22, 2016.

Exposures: Alcohol consumption was divided into 4 categories: abstainers (never drinkers), former drinkers, 7 or fewer alcoholic drinks per week, and more than 7 drinks per week.

Primary Outcomes and Measures: Participant survival after the diagnosis of incident heart failure.

Results: Among the 393 adults diagnosed with incident heart failure, 213 (54.2\%) were female, 339 (86.3\%) were white, and the mean (SD) age was 78.7 (6.0) years. Alcohol consumption after diagnosis was reported in 129 (32.8\%) of the participants. Across alcohol consumption categories of long-term abstainers, former drinkers, consumers of 1-7 drinks weekly and consumers of more than 7 drinks weekly, the percentage of men (32.1\%, 49.0\%, 58.0\%, and 82.4\%, respectively; P < .001 for trend), white individuals (78.0\%, 92.7\%, 92.0\%, and 94.1\%, respectively, P <. 001 for trend), and high-income participants (22.0\%, 43.8\%, 47.3\%, and 64.7\%, respectively; P < .001 for trend) increased with increasing alcohol consumption. Across the 4 categories, participants who consumed more alcohol had more years of education (mean, 12 years [interquartile range (IQR), 8.0-10.0 years], 12 years [IQR, 11.0-14.0 years], 13 years [IQR, 12.0-15.0 years], and 13 years [IQR, 12.0-14.0 years]; P < .001 for trend). Diabetes was less common across the alcohol consumption categories (32.1\%, 26.0\%, 22.3\%, and 5.9\%, respectively; P = .01 for trend). Across alcohol consumption categories, there were fewer never smokers (58.3\%, 44.8\%, 35.7\%, and 29.4\%, respectively; P < .001 for trend) and more former smokers (34.5\%, 38.5\%, 50.0\%, and 52.9\%, respectively; P = .006 for trend). After controlling for other factors, consumption of 7 or fewer alcoholic drinks per week was associated with additional mean survival of 383 days (95\% CI, 17-748 days; P = .04) compared with abstinence from alcohol. Although the robustness was limited by the small number of individuals who consumed more than 7 drinks per week, a significant inverted U-shaped association between alcohol consumption and survival was observed. Multivariable model estimates of mean time from heart failure diagnosis to death were 2640 days (95\% CI, 1967-3313 days) for never drinkers, 3046 days (95\% CI, 2372-3719 days) for consumers of 0 to 7 drinks per week, and 2806 (95\% CI, 1879-3734 days) for consumers of more than 7 drinks per week (P = .02). Consumption of 10 drinks per week was associated with the longest survival, a mean of 3381 days (95\% CI, 2806-3956 days) after heart failure diagnosis.

Conclusions and Relevance: These findings suggest that limited alcohol consumption among older adults with incident heart failure is associated with survival benefit compared with long-term abstinence. These findings suggest that older adults who develop heart failure may not need to abstain from moderate levels of alcohol consumption.

}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2018.6383}, author = {Sadhu, Justin S and Novak, Eric and Mukamal, Kenneth J and Kizer, Jorge R and Psaty, Bruce M and Stein, Phyllis K and Brown, David L} }