Incidence and Risk of Heart Failure in Patients With Coronary Heart Disease and Stroke: A Population-Based Cohort Study

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-05-06 DOI:10.1016/j.amjcard.2025.04.028

Xiaofei Liu MS , Peng Shen MD , Yi Chen MS , Yexiang Sun MPH , Qi Chen MPH , Hongbo Lin MD , Xun Tang PhD, MHS , Pei Gao PhD

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引用次数: 0

Abstract

Heart failure (HF) is a major global health issue, with coronary heart disease (CHD) and stroke being risk factors with different mechanisms. The risk of HF in stroke patients remain poorly characterized despite the potential contributions of "stroke-heart syndrome." This study aimed to evaluate HF incidence and risk factors across different cardiovascular disease (CVD) subtypes in a large population-based Chinese cohort. This study included 13,258 CVD patients, i.e. 3,470 patients with CHD (including 610 with myocardial infarction [MI]) and 10,048 with total stroke (comprising 8,631 ischemic and 1,515 hemorrhagic stroke), and 66,290 age- and sex-matched controls without CVD (1:5 ratio). The primary outcome was new-onset HF. Cumulative incidence functions were estimated with non-HF death as a competing event, stratified by CVD subtypes. Cox proportional hazard models were used to assess the risk factors of HF and compare relative hazard ratio (HR) between CHD and stroke patients. The 10-year cumulative incidence of HF was 25.3% in patients with CHD (24.6% in MI patients), 13.5% in stroke patients (14.7% and 7.3% for ischemic and hemorrhagic stroke, respectively), and 6.9% in controls. Hypertension (81.8% in CHD, 81.0% in stroke) significantly increased HF risk compared to those without it (incidence rate ratio: 1.74, 95% CI: 1.41 to 2.12 for stroke; 1.42, 95% CI: 1.12 to 1.78 for CHD). Obesity showed a stronger association with HF in stroke patients than in CHD patients (HR: 1.43, 95%CI: 1.15 to 1.78 vs 0.94, 95%CI: 0.69 to 1.28, ratio of HRs: 1.67, 95% CI: 1.14 to 2.42). Other significant risk factors in both CHD and stroke patients include older age, male sex, former smoking, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. In conclusion, heart failure incidence varies by CVD subtypes, with the highest risk rates in CHD and MI patients, followed by stroke. Hypertension and obesity notably increase HF risk for stroke patients. Tailored risk management strategies are needed, considering the differential impact of risk factors across CVD subtypes.

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冠心病和脑卒中患者心力衰竭的发生率和风险：一项基于人群的队列研究

心力衰竭（HF）是一个主要的全球健康问题，冠心病（CHD）和脑卒中是具有不同机制的危险因素。尽管有“卒中-心脏综合征”的潜在影响，但卒中患者发生HF的风险特征仍然很差。本研究旨在评估中国大型人群中不同心血管疾病（CVD）亚型的心衰发生率和危险因素。本研究纳入13258例CVD患者，即3470例冠心病患者（包括610例心肌梗死[MI]）和10048例全脑卒中患者（包括8631例缺血性卒中和1515例出血性卒中），以及66290例年龄和性别匹配的无CVD对照（1:5比例）。主要终点为新发心衰。将非心衰死亡作为竞争事件，按CVD亚型分层，估计累积发生率函数。采用Cox比例风险模型评估心衰的危险因素，比较冠心病与脑卒中患者的相对危险比（HR）。冠心病患者10年累积HF发病率为25.3%（心肌梗死患者为24.6%），卒中患者为13.5%（缺血性卒中和出血性卒中分别为14.7%和7.3%），对照组为6.9%。高血压（冠心病发生率为81.8%，卒中发生率为81.0%）显著增加心衰风险(卒中发生率比：1.74,95%CI: 1.41-2.12；1.42, 95%CI: 1.12-1.78冠心病)。卒中患者肥胖与HF的相关性高于冠心病患者（HR: 1.43, 95%CI: 1.15-1.78 vs 0.94, 95%CI: 0.69-1.28, HR: 1.67, 95%CI: 1.14-2.42）。冠心病和中风患者的其他重要危险因素包括年龄较大、男性、以前吸烟、糖尿病、慢性肾脏疾病和慢性阻塞性肺病。综上所述，心力衰竭的发病率因心血管疾病亚型而异，冠心病和心肌梗死患者的风险最高，其次是中风。高血压和肥胖显著增加脑卒中患者的心衰风险。考虑到不同心血管疾病亚型的风险因素的不同影响，需要有针对性的风险管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.