MODIFIABLE RISK-FACTORS FOR INCIDENT HEART-FAILURE IN THE CORONARY-ARTERY SURGERY STUDY

Background: Even with aggressive treatment, heart failure is associate d with a substantial morbidity and mortality. This poor prognosis has led to increasing interest in primary prevention, and the identificati on of modifiable risk factors. Our objective was to determine whether modifiable cardiovascular risk factors, including systolic and diastol ic blood pressure, fasting glucose level, cholesterol level, weight, a nd smoking, were independent risk factors for heart failure in patient s with anatomically confirmed coronary artery disease. Methods: We stu died all patients with documented coronary artery disease eligible for the multicenter, randomized-controlled Coronary Artery Surgery Study. After excluding 79 prevalent cases, we identified incident cases of h eart failure using hospital discharge abstracts, mortality records, or self-reported follow-up questionnaires. Criteria for self-reported ca ses were treatment with digitalis and/or furosemide plus two or more h eart failure symptoms, including dyspnea on exertion, orthopnea, parox ysmal nocturnal dyspnea, or edema. Cox regression analysis was used to estimate adjusted relative risks. Results: At 12-year follow-up, the cumulative incidence of heart failure was 20.6%. Smoking (relative ris k, 1.47) and weight (relative risk, 1.15/10 kg) were independently ass ociated with incident heart failure. Myocardial infarction during foll ow-up, age, female sex, and baseline left ventricular dysfunction were also risk factors for heart failure. Conclusions: Patients with stabl e coronary artery disease are at high risk for developing heart failur e, especially following myocardial infarction. However, interventions aimed at smoking cessation and weight reduction may prevent clinical h eart failure in these patients.