Abstract 17111: Temporal Trends in the Incidence of Heart Failure and its Risk Factors
Background: It has been proposed that the rising population burden of cardiovascular risk factors is driving an epidemic of heart failure (HF). However, few studies have simultaneously examined the secular trends in heart failure and its risk factors.
Methods: In 22067 male participants (mean age 55 years) of the Physician's Health Study I, we examined secular trends for diabetes, hypertension, hyperlipidemia, myocardial infarction (MI) and HF between years 1984 and 2004. We used Cox proportional hazards models to estimate the risk for occurrence of each condition in time periods 1989-1993, 1994-1998 and 1999-2004 using 1984-1988 as the referent period.
Results: Over the 4 time periods, we observed an increase in the incidence of diabetes, hypertension, and hyperlipidemia (Table). After adjustment for age and covariates, there was a graded increase in the risk for diabetes, hypertension and hyperlipidemia in the latter time-periods compared to the referent period (Table). In contrast, we noted a statistically significant decreased risk for MI occurrence in the later time-periods, compared to the referent period. However, the incidence of HF increased over the 4 time-periods we evaluated, an effect that was largely accounted for by age and changing prevalence of other factors (Table).
Conclusion: Although there has been a significant decrease in MI risk over the past three decades, the incidence of HF has increased in parallel to increase in diabetes, hypertension and hyperlipidemia incidence, suggesting that these conditions may be driving the HF epidemic.
Footnotes for Table: PY = person years; HR = Hazards ratio; CI = confidence interval Cox model adjusted for * age, hypertension, smoking, body-mass index (BMI) and treatment arm (ASA) † age, diabetes, smoking, BMI and ASA ‡ age, diabetes, smoking, BMI, alcohol use and ASA § age, diabetes, hypertension, smoking, BMI, ASA and HF ¥ age, diabetes, hypertension, smoking, BMI, ASA and prevalent and incident MI.
- © 2011 by American Heart Association, Inc.