CAC measurements predict HFpEF risk in women
Usefulness of Coronary Artery Calcium to Predict Heart Failure with Preserved Ejection Fraction in Men Versus Women (From the Multi-Ethnic Study of Atherosclerosis)Literature - Sharma K, Al Rifai M, Ahmed HM, et al. - Am J of Cardiol 2017; published online ahead of print
- During the median follow-up time of 11.2 years, there were 127 incident HF hospitalizations.
- The overall incidence rate of HFpEF was 1.82 per 1000 person-years (PY). Incidence rates were slightly higher for men compared to women (2.00 vs. 1.66 events per 1000 PY, respectively, P=0.29).
- HFpEF incidence gradually raised as CAC scores increased: for CAC=0: 0.99 events per 1000 PY; for CAC 1-100: 1.48 events per 1000 PY; for CAC 101-300: 2.95 events per 1000 PY, and for CAC >300: 5.39 events per 1000 PY.
- HFpEF risk was significantly higher in the CAC 101-300 and >300 group compared with CAC=0 (unadjusted HR: 2.99; 95%CI: 1.76-5.08; and HR: 5.50; 95%CI: 3.52-8.59, respectively, P for trend <0.001).
- After adjustment, the differences were not significant any longer, but a trend remained for higher risk with increasing CAC (P=0.02).
- There was a 4-fold increase in HFpEF risk for every 1 unit increase in log-transformed CAC, which was no longer significant after adjustment (HR: 1.12; 95%CI: 0.60-2.09).
- There was a significant interaction between CAC and gender (P for interaction=0.03 for both continuous and categorical CAC).
- After adjustment, CAC>300 in females was associated with a 2.81-fold increase in risk of HFpEF (95%CI: 1.32-5.95; P for trend <0.001).
In asymptomatic individuals without clinical CVD, the measurement of CAC was associated with the risk of HFpEF in women and may therefore be helpful for the risk stratification of HFpEF in women. These findings suggest that CAC may be used to identify and introduce appropriate preventive measures for women at high risk of HFpEF.