Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: Insights from the framingham heart study of the national heart, lung, and blood institute

Douglas S. Lee, Philimon Gona, Ramachandran S. Vasan, Martin G. Larson, Emelia J. Benjamin, Thomas J. Wang, Jack V. Tu, Daniel Levy

Research output: Contribution to journalArticle

415 Scopus citations

Abstract

BACKGROUND: The contributions of risk factors and disease pathogenesis to heart failure with preserved ejection fraction (HFPEF) versus heart failure with reduced ejection fraction (HFREF) have not been fully explored. METHODS AND RESULTS: We examined clinical characteristics and risk factors at time of heart failure onset and long-term survival in Framingham Heart Study participants according to left ventricular ejection fraction ĝ‰Currency sign45% (n≤314; 59%) versus >45% (n≤220; 41%) and hierarchical causal classification. Heart failure was attributed to coronary heart disease in 278 participants (52%), valvular heart disease in 42 (8%), hypertension in 140 (26%), or other/unknown causes in 74 (14%). Multivariable predictors of HFPEF (versus HFREF) included elevated systolic blood pressure (odds ratio [OR]≤1.13 per 10 mm Hg; 95% confidence interval [CI], 1.04 to 1.22), atrial fibrillation (OR≤4.23; 95% CI, 2.38 to 7.52), and female sex (OR≤2.29; 95% CI, 1.35 to 3.90). Conversely, prior myocardial infarction (OR≤0.32; 95% CI, 0.19 to 0.53) and left bundle-branch block QRS morphology (OR≤0.21; 95% CI, 0.10 to 0.46) reduced the odds of HFPEF. Long-term prognosis was grim, with a median survival of 2.1 years (5-year mortality rate, 74%), and was equally poor in men and women with HFREF or HFPEF. CONCLUSIONS: Among community patients with new-onset heart failure, there are differences in causes and time-of-onset clinical characteristics between those with HFPEF versus HFREF. In people with HFREF, mortality is increased when coronary heart disease is the underlying cause. These findings suggest that heart failure with reduced left ventricular systolic function and heart failure with preserved left ventricular systolic function are partially distinct entities, with potentially different approaches to early detection and prevention.

Original languageEnglish (US)
Pages (from-to)3070-3077
Number of pages8
JournalCirculation
Volume119
Issue number24
DOIs
StatePublished - Jun 23 2009
Externally publishedYes

Keywords

  • Coronary disease
  • Epidemiology
  • Heart diseases
  • Heart failure
  • Hypertension
  • Mortality
  • Ventricles

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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