Heart failure (HF) is a risk factor for incident stroke. However, less is known about
the independent nature of this association and to what extent various baseline characteristics
may mediate this risk. Of the 5,795 community-dwelling adults aged ≥65 years in the
Cardiovascular Health Study, 5,448 were free of baseline stroke, of whom 229 had baseline
HF. We used a multivariable-adjusted Cox regression model to estimate hazard ratios
(HRs) and 95% confidence intervals (CIs) for centrally adjudicated incident stroke
associated with HF. Participants had a mean age of 73 years, 58% were women, and 15%
were African-American. During 23 years of follow-up, incident stroke occurred in 18.8%
and 19.3% of those with and without HF, respectively, but the time to first stroke
was shorter in those with HF (age-gender-race-adjusted HR 1.64, 95% CI 1.21 to 2.25).
The association remained essentially unchanged after adjustments for tobacco, alcohol,
and physical activity (HR 1.63, 95% CI 1.21 to 2.24), attenuated after adjustment
for hypertension, atrial fibrillation, myocardial infarction, and diabetes mellitus
(HR 1.26, 95% CI 0.92 to 1.72), and further attenuated after additional adjustment
for 10 baseline functional and subclinical variables (HR 1.05, 95% CI 0.76 to 1.46).
In conclusion, despite a similar 23-year stroke incidence, time to first stroke was
shorter in older adults with HF than without. However, this extra risk appears to
be mediated primarily by 4 cardiovascular diseases that are also risk factors for
HF. These findings highlight the importance of the primary prevention of these HF
risk factors to reduce the extra risk of stroke in HF.
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References
- Heart failure as a risk factor for stroke.J Stroke. 2018; 20: 33-45
- Costs of hospitalization for stroke patients aged 18–64 years in the United States.J Stroke Cerebrovasc Dis. 2014; 23: 861-868
- Epidemiology and aetiology of heart failure.Nat Rev Cardiol. 2016; 13: 368-378
- Risk of stroke in patients with heart failure: A population-based 30-year cohort study.Stroke. 2017; 48: 1161-1168
- The Cardiovascular Health Study: design and rationale.Ann Epidemiol. 1991; 1: 263-276
- A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509
- Introduction to the analysis of survival data in the presence of competing risks.Circulation. 2016; 133: 601-609
- Exercise intensity and subclinical cardiovascular disease in the elderly. The cardiovascular health study.Am J Epidemiol. 1997; 145: 977-986
- Prevention of heart failure in older adults may require higher levels of physical activity than needed for other cardiovascular events.Int J Cardiol. 2013; 168: 1905-1909
- Cardiovascular risk factors for acute stroke: risk profiles in the different subtypes of ischemic stroke.World J Clin Cases. 2015; 3: 418-429
- Heart failure and stroke.Curr Heart Fail Rep. 2018; 15: 287-296
- Heart failure and the risk of stroke: the Rotterdam Study.Eur J Epidemiol. 2010; 25: 807-812
- Warfarin versus aspirin in patients with reduced cardiac ejection fraction (WARCEF): rationale, objectives, and design.J Card Fail. 2006; 12: 39-46
- Ischemic stroke after heart failure: a community-based study.Am Heart J. 2006; 152: 102-109
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Vital statistics of the United States, 1993: preprint of volume II, mortality, Part A, Section 6. Available at: https://www.cdc.gov/nchs/data/lifetables/life93_2.pdf. Accessed on July 31, 2022.
- Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years.JAMA. 2006; 296: 2939-2946
- The lifetime risk of stroke: estimates from the Framingham Study.Stroke. 2006; 37: 345-350
Article info
Publication history
Published online: December 10, 2022
Received in revised form:
October 4,
2022
Received:
August 6,
2022
Footnotes
Funding: Dr. Ahmed was in part supported by grants R01-HL085561, R01-HL085561-S, and R01-HL097047 from the National Heart, Lung, and Blood Institute (NHLBI) and grant I01HX002422 from Department of Veterans Affairs. OPTIMIZE-HF was sponsored by GlaxoSmithKline but played no role in the design, conduct, analyses, or interpretation of the current study.
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