Abstract 3111: Reverse Epidemiology in Chronic Heart Failure: Cumulative Predictive Power of Classical Cardiovascular Risk Factors
Background: Observational studies indicated that in chronic heart failure (CHF) several classical cardiovascular risk factors (RF) were counterintuitively associated with improved survival (ie, “reverse epidemiology”). This was demonstrated for higher levels of body mass index (BMI), systolic blood pressure (BP) and total cholesterol (TC). We analysed the cumulative prognostic effects of these RF in CHF.
Methods: Tertiles of BMI, BP and TC were calculated separately for patients with systolic and non-systolic CHF. After a median follow-up time of 505 days (IQR 262–786) 30% had died (100% follow-up). Results: 633 consecutively recruited patients with systolic (51%) or non-systolic (49%) CHF were analysed: mean age 68±13y, 37% female, NYHA class I–IV 7/32/40/11%. Values in the highest tertile of any of these RF were associated with the lowest mortality risk (all p<0.0001, univariable Cox regression). Patients with 3 RF in the highest tertile had the lowest (HR=1.0=referent) and patients with 3 RF in the lowest tertile had the highest mortality risk (HR 7.64, 95%CI 1.88–31.0; P=0.004, figure⇓). These associations remained robust after multivariable adjustment for age, sex and NYHA class (HR 5.43, 95%CI 1.33–22.1; P=0.018), and further for use of statin, ACE inhibitor/ARB, betablocker and spironolactone (HR 4.88, 95%CI 1.20–19.9; P=0.027).
Conclusion: In CHF, low levels of BMI, BP and TC are associated with worse outcome on a cumulative scale. The question remains open to further studies whether tight control of classical cardiovascular RF, e.g. in patients with coronary heart disease, should also be generally recommended in more advanced CHF.