Search

Supplemental Digital Content is available in the text.

Background:Several heart failure (HF) risk factors, including hypertension, diabetes mellitus, obesity, and physical activity, are well described. However, the degree to which optimization of these modifiable risk factors might impact the incidence of HF is not yet fully defined.Hypothesis:We hypothesized more optimal control of major modifiable HF risk factors is associated with progressively lower HF risk.Methods:We performed a prospective analysis of 13,534 ARIC participants (mean age 57, 55% female), examining HF risk associations of different cutpoints of glycemia (HbA1c), systolic blood pressure (SBP), body mass index (BMI) and physical activity (assessed at Visit 2 [1990-92], except for physical activity assessed at Visit 1 (1987-89]). Optimal risk factor control was defined as HbA1c < 7%, SBP < 120 mmHg, BMI 18.5-25 kg/m2, and AHA-recommended activity levels. Severely uncontrolled risk factors were defined as HbA1c > 8%, SBP > 160 mmHg, BMI > 35 kg/m2and no exercise physical activity. Intermediate values were considered mild to moderately uncontrolled. Cox models simultaneously including all risk factors were constructed to assess associations of risk factor levels with incident HF (by discharge codes) after Visit 2 through 2016.Results:There were 2,827 HF events over a median 24 years of follow-up. Risk gradations were seen across categorizations of each risk factor (Table). In the full model, relative to optimal control, HRs were 2.06 for BMI ≥ 35 kg/m2, 1.16 for poor physical activity, 2.31 for HbA1c > 8% and 1.80 for SBP ≥ 160 mmHg. No risk gradient was seen from SBP < 120 to 140 mmHg among hypertensives. Incidence rates (per 1000 PYs) were 7.9 for all optimally controlled risk factors, 14.5 for 3-4 mild to moderately uncontrolled risk factors and 39.5 for 3-4 severely uncontrolled risk factors.Conclusion:Optimal control of modifiable risk factors is strongly linked to lower HF risk. Our findings suggest prioritizing optimization of existing risk factors may be central to successful strategies to prevent HF onset.