02667nas a2200301 4500008004100000022001400041245011000055210006900165260001300234300001200247490000700259520176900266100002002035700002202055700002202077700002202099700002002121700002102141700002302162700002302185700002002208700001602228700002202244700002602266700002102292700001602313856003602329 2021 eng d a1532-841400aAssociation of Midlife Cardiovascular Risk Factors With the Risk of Heart Failure Subtypes Later in Life.0 aAssociation of Midlife Cardiovascular Risk Factors With the Risk c2021 Apr a435-4440 v273 a

BACKGROUND: Independent associations between cardiovascular risk factor exposures during midlife and later life development of heart failure (HF) with preserved ejection fraction (HFpEF) versus reduced EF (HFrEF) have not been previously studied.

METHODS: We pooled data from 4 US cohort studies (Atherosclerosis Risk in Communities, Cardiovascular Health, Health , Aging and Body Composition, and Multi-Ethnic Study of Atherosclerosis) and imputed annual risk factor trajectories for body mass index, systolic and diastolic blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol, and glucose starting from age 40 years. Time-weighted average exposures to each risk factor during midlife and later life were calculated and analyzed for associations with the development of HFpEF or HFrEF.

RESULTS: A total of 23,861 participants were included (mean age at first in-person visit, 61.8 ±1 0.2 years; 56.6% female). During a median follow-up of 12 years, there were 3666 incident HF events, of which 51% had EF measured, including 934 with HFpEF and 739 with HFrEF. A high midlife systolic blood pressure and low midlife high-density lipoprotein cholesterol were associated with HFrEF, and a high midlife body mass index, systolic blood pressure, pulse pressure, and glucose were associated with HFpEF. After adjusting for later life exposures, only midlife pulse pressure remained independently associated with HFpEF.

CONCLUSIONS: Midlife exposure to cardiovascular risk factors are differentially associated with HFrEF and HFpEF later in life. Having a higher pulse pressure during midlife is associated with a greater risk for HFpEF but not HFrEF, independent of later life exposures.

1 aCohen, Laura, P1 aVittinghoff, Eric1 aPletcher, Mark, J1 aAllen, Norrina, B1 aShah, Sanjiv, J1 aWilkins, John, T1 aChang, Patricia, P1 aNdumele, Chiadi, E1 aNewman, Anne, B1 aIves, Diane1 aMaurer, Mathew, S1 aOelsner, Elizabeth, C1 aMoran, Andrew, E1 aZhang, Yiyi uhttps://chs-nhlbi.org/node/8703