03609nas a2200397 4500008004100000022001400041245007200055210006900127260001600196300001300212490000800225520257600233653001002809653000902819653001902828653002802847653001902875653002202894653001102916653001602927653001102943653002602954653000902980653001602989653001403005653000903019653001703028653001203045100002103057700001803078700001803096700001603114700001803130700002703148856003603175 2012 eng d a1538-359800aLifetime risk and years lived free of total cardiovascular disease.0 aLifetime risk and years lived free of total cardiovascular disea c2012 Nov 07 a1795-8010 v3083 a

CONTEXT: Estimates of lifetime risk for total cardiovascular disease (CVD) may provide projections of the future population burden of CVD and may assist in clinician-patient risk communication. To date, no lifetime risk estimates of total CVD have been reported.

OBJECTIVES: To calculate lifetime risk estimates of total CVD by index age (45, 55, 65, 75 years) and risk factor strata and to estimate years lived free of CVD across risk factor strata.

DESIGN, SETTING, AND PARTICIPANTS: Pooled survival analysis of as many as 905,115 person-years of data from 1964 through 2008 from 5 National Heart, Lung, and Blood Institute-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study, and Cardiovascular Health Study. All participants were free of CVD at baseline with risk factor data (blood pressure [BP], total cholesterol [TC], diabetes, and smoking status) and total CVD outcome data.

MAIN OUTCOME MEASURES: Any total CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths).

RESULTS: At an index age of 45 years, overall lifetime risk for total CVD was 60.3% (95% CI, 59.3%-61.2%) for men and 55.6% (95% CI, 54.5%-56.7%) for women. Men had higher lifetime risk estimates than women across all index ages. At index ages 55 and 65 years, men and women with at least 1 elevated risk factor (BP, 140-149/90-99 mm Hg; or TC, 200-239 mg/dL; but no diabetes or smoking), 1 major risk factor, or at least 2 major risk factors (BP, ≥160/100 mm Hg or receiving treatment; TC, ≥240 mg/dL or receiving treatment; diabetes mellitus; or current smoking) had lifetime risk estimates to age 95 years that exceeded 50%. Despite an optimal risk factor profile (BP, <120/80 mm Hg; TC, <180 mg/dL; and no smoking or diabetes), men and women at the index age of 55 years had lifetime risks (through 85 years of age) for total CVD of greater than 40% and 30%, respectively. Compared with participants with at least 2 major risk factors, those with an optimal risk factor profile lived up to 14 years longer free of total CVD.

CONCLUSIONS: Lifetime risk estimates for total CVD were high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.

10aAdult10aAged10aBlood Pressure10aCardiovascular Diseases10aCohort Studies10aDiabetes Mellitus10aFemale10aForecasting10aHumans10aKaplan-Meier Estimate10aMale10aMiddle Aged10aMorbidity10aRisk10aRisk Factors10aSmoking1 aWilkins, John, T1 aNing, Hongyan1 aBerry, Jarett1 aZhao, Lihui1 aDyer, Alan, R1 aLloyd-Jones, Donald, M uhttps://chs-nhlbi.org/node/586103473nas a2200409 4500008004100000022001400041245025300055210006900308260001300377300001100390490000600401520217700407653000902584653001502593653002102608653001102629653001802640653001102658653003402669653000902703653003102712653002202743653001402765653002402779653001702803653001502820100002402835700002002859700002002879700002402899700002102923700002102944700001802965700001702983700002703000856003603027 2015 eng d a2213-178700aOlder Adults, "Malignant" Left Ventricular Hypertrophy, and Associated Cardiac-Specific Biomarker Phenotypes to Identify the Differential Risk of New-Onset Reduced Versus Preserved Ejection Fraction Heart Failure: CHS (Cardiovascular Health Study).0 aOlder Adults Malignant Left Ventricular Hypertrophy and Associat c2015 Jun a445-550 v33 a

OBJECTIVES: This study hypothesized that biomarkers of subclinical myocardial injury (high-sensitivity cardiac troponin T [hs-cTnT]) and hemodynamic stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP]) would differentiate heart failure (HF) risk among older adults with left ventricular hypertrophy (LVH).

BACKGROUND: The natural history of LVH, an important risk factor for HF, is heterogeneous.

METHODS: NT-proBNP and hs-cTnT were measured at baseline and after 2 to 3 years in older adults without prior HF or myocardial infarction in the CHS (Cardiovascular Health Study). LVH and left ventricular ejection fraction were determined by echocardiography. HF events were adjudicated over a median of 13.1 years and classified as preserved or reduced left ventricular ejection fraction (heart failure with preserved ejection fraction or heart failure with reduced ejection fraction [HFrEF]). Adjusted risk of HF by LVH and biomarker tertiles, and by LVH and longitudinal increase in each biomarker was estimated using Cox regression.

RESULTS: Prevalence of LVH was 12.5% among 2,347 participants with complete measures. Adjusted risk of HF (N = 643 events) was approximately 3.8-fold higher among participants with LVH and in the highest biomarker tertile, compared with those with low biomarker levels without LVH (NT-proBNP, hazard ratio [HR]: 3.78; 95% confidence interval [CI]: 2.78 to 5.15 and hs-cTnT, HR: 3.86; 95% CI: 2.84 to 5.26). The adjusted risk of HFrEF was 7.8 times higher among those with the highest tertile of hs-cTnT and LVH (HR: 7.83; 95% CI: 4.43 to 13.83). Those with LVH and longitudinal increases in hs-cTnT or NT-proBNP were approximately 3-fold more likely to develop HF, primarily HFrEF, compared with those without LVH and with stable biomarkers.

CONCLUSIONS: The combination of LVH with greater hs-cTnT or NT-proBNP levels, and their longitudinal increase, identifies older adults at highest risk for symptomatic HF, especially HFrEF. These biomarkers may characterize sub-phenotypes in the transition from LVH to HF and suggest modifiable targets for prevention.

10aAged10aBiomarkers10aEchocardiography10aFemale10aHeart Failure10aHumans10aHypertrophy, Left Ventricular10aMale10aNatriuretic Peptide, Brain10aPeptide Fragments10aPhenotype10aProspective Studies10aRisk Factors10aTroponin T1 aSeliger, Stephen, L1 ade Lemos, James1 aNeeland, Ian, J1 aChristenson, Robert1 aGottdiener, John1 aDrazner, Mark, H1 aBerry, Jarett1 aSorkin, John1 aDeFilippi, Christopher uhttps://chs-nhlbi.org/node/6735