Association of Health Aging and Body Composition (ABC) HF Score
Association of Health Aging and Body Composition (ABC) HF Score
Background The Health ABC Heart Failure score has recently been shown to predict 5-year risk of incident heart failure in the elderly. We tested whether this risk score is associated with subclinical phenotypes of heart failure in a younger population.
Methods We stratified participants in the Dallas Heart Study aged 30 to 65 years who had a cardiac magnetic resonance imaging and no self-reported history of heart failure or cardiomyopathy into 4 previously defined Health ABC Heart Failure risk groups: low (<5%), average (5%-10%), high (10%-20%), and very high (>20% risk for heart failure within 5 years). We compared left ventricular (LV) structural and functional parameters and levels of B-type natriuretic peptide (BNP) and N-terminal proBNP among the 4 groups.
Results In the study cohort (N = 2,540), the percentage of subjects in the low-, average-, high-, and very high risk groups was 78%, 15%, 6%, and 1%, respectively. Indexed LV mass (80 ± 15 vs 90 ± 20 vs 95 ± 25 vs 116 ± 41 g/m), concentricity (1.6 ± 0.3 vs 1.8 ± 0.4 vs 2.0 ± 0.5 vs 2.2 ± 0.7 g/mL), median BNP (2.8 vs 3.7 vs 4.9 vs 7.5 pg/mL) and N-terminal proBNP (26 vs 30 vs 40 vs 58 pg/mL), and prevalent LV systolic dysfunction and LV hypertrophy progressively increased across risk groups (P < .001 for all) independent of gender or method of indexing LV mass.
Conclusions The Health ABC Heart Failure score was associated with subclinical cardiac structural changes in the general population 30 to 65 years of age, suggesting that it may be a valid tool for identification of young individuals at increased risk for heart failure.
The incidence of heart failure continues to increase despite advances in its evaluation and treatment. One strategy to reverse this trend is to develop tools that identify individuals at increased risk for heart failure, thereby allowing initiation of therapies to prevent or slow its onset. In addition to screening the population with biomarkers or echocardiography, multimarker risk scores based on a composite of clinical characteristics have been advocated for this purpose. Recently, the Health Aging and Body Composition (ABC) Heart Failure (HF) score was developed and validated in a multiethnic elderly population enrolled in the Health ABC study to predict the 5-year risk of incident symptomatic heart failure and found to be superior to the Framingham Heart Failure Risk Score for this purpose.
It is not known whether the Health ABC HF risk score is a valid tool to assess the risk of incident heart failure in younger individuals. Although elderly individuals are at an increased short-term risk for heart failure as compared with younger individuals, a large proportion of young individuals also have a predicted lifetime risk of heart failure (20%) that is similar to the predicted lifetime risk for elderly individuals. Therefore, strategies are needed to assess the risk of incident heart failure in younger individuals.
Subclinical cardiac structural changes such as left ventricular hypertrophy (LVH) and low LV ejection fraction (LVEF) are considered to be an intermediate stage to development of symptomatic heart failure. Moreover, LVH has been associated with adverse cardiovascular outcomes including the development of a depressed LVEF, heart failure, and overall mortality. In view of this, we tested whether the Health ABC HF score was associated with cardiac structural and functional changes in younger individuals. If so, these data would provide strong support that this tool would be a valid measure of risk of incident heart failure in this population.
Abstract and Introduction
Abstract
Background The Health ABC Heart Failure score has recently been shown to predict 5-year risk of incident heart failure in the elderly. We tested whether this risk score is associated with subclinical phenotypes of heart failure in a younger population.
Methods We stratified participants in the Dallas Heart Study aged 30 to 65 years who had a cardiac magnetic resonance imaging and no self-reported history of heart failure or cardiomyopathy into 4 previously defined Health ABC Heart Failure risk groups: low (<5%), average (5%-10%), high (10%-20%), and very high (>20% risk for heart failure within 5 years). We compared left ventricular (LV) structural and functional parameters and levels of B-type natriuretic peptide (BNP) and N-terminal proBNP among the 4 groups.
Results In the study cohort (N = 2,540), the percentage of subjects in the low-, average-, high-, and very high risk groups was 78%, 15%, 6%, and 1%, respectively. Indexed LV mass (80 ± 15 vs 90 ± 20 vs 95 ± 25 vs 116 ± 41 g/m), concentricity (1.6 ± 0.3 vs 1.8 ± 0.4 vs 2.0 ± 0.5 vs 2.2 ± 0.7 g/mL), median BNP (2.8 vs 3.7 vs 4.9 vs 7.5 pg/mL) and N-terminal proBNP (26 vs 30 vs 40 vs 58 pg/mL), and prevalent LV systolic dysfunction and LV hypertrophy progressively increased across risk groups (P < .001 for all) independent of gender or method of indexing LV mass.
Conclusions The Health ABC Heart Failure score was associated with subclinical cardiac structural changes in the general population 30 to 65 years of age, suggesting that it may be a valid tool for identification of young individuals at increased risk for heart failure.
Introduction
The incidence of heart failure continues to increase despite advances in its evaluation and treatment. One strategy to reverse this trend is to develop tools that identify individuals at increased risk for heart failure, thereby allowing initiation of therapies to prevent or slow its onset. In addition to screening the population with biomarkers or echocardiography, multimarker risk scores based on a composite of clinical characteristics have been advocated for this purpose. Recently, the Health Aging and Body Composition (ABC) Heart Failure (HF) score was developed and validated in a multiethnic elderly population enrolled in the Health ABC study to predict the 5-year risk of incident symptomatic heart failure and found to be superior to the Framingham Heart Failure Risk Score for this purpose.
It is not known whether the Health ABC HF risk score is a valid tool to assess the risk of incident heart failure in younger individuals. Although elderly individuals are at an increased short-term risk for heart failure as compared with younger individuals, a large proportion of young individuals also have a predicted lifetime risk of heart failure (20%) that is similar to the predicted lifetime risk for elderly individuals. Therefore, strategies are needed to assess the risk of incident heart failure in younger individuals.
Subclinical cardiac structural changes such as left ventricular hypertrophy (LVH) and low LV ejection fraction (LVEF) are considered to be an intermediate stage to development of symptomatic heart failure. Moreover, LVH has been associated with adverse cardiovascular outcomes including the development of a depressed LVEF, heart failure, and overall mortality. In view of this, we tested whether the Health ABC HF score was associated with cardiac structural and functional changes in younger individuals. If so, these data would provide strong support that this tool would be a valid measure of risk of incident heart failure in this population.
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