In HFpEF, ischemia associated with major adverse events
Among patients with HF with preserved ejection fraction, those with ischemic heart disease had increased risk for major adverse renal and/or cardiac events, according to study findings published in The American Journal of Cardiology.
“The epidemiology and pathophysiology of HF with preserved ejection fraction is an ongoing challenge. ... Further, ischemic heart disease is one of many identified risk factors for HF,” Gelareh Rahimi, PhD, biostatistician at Baylor Scott & White Health, and colleagues wrote. “However, current evidence on the prognostic role of ischemia in HFpEF is conflicting. ... Accordingly, it is of interest to quantify the impact of ischemia on major adverse renal and/or cardiac events (MARCE) in patients with HFpEF.”
In a post hoc analysis, researchers analyzed 3,445 patients with HFpEF aged at least 50 years from the TOPCAT trial. Researchers conducted propensity score matching to compare patients with myocardial ischemia (n = 1,747) with patients without myocardial ischemia (n = 1,207) in terms of MARCE. Follow-up concluded at an average of 3.3 years.
According to the researchers, ischemia was associated with a 20% increased risk for MARCE (HR = 1.2; 95% CI, 1.042-1.382; P = .0112). Further, diabetes (HR = 1.6; 95% CI, 1.38-1.87; P < .0001), dyslipidemia (HR = 1.3; 95% CI, 1.1-1.52; P = .001) and smoking (HR = 1.33; 95% CI, 1.04-1.69; P = .0197) increased risk for MARCE by 60%, 30% and 33%, respectively.
In a subgroup analysis, patients with a history of revascularization (38%) had twofold risk for MARCE (HR = 2.19; 95% CI, 1.87-2.57; P < .0001) compared with those who had not undergone revascularization.
“Ischemic heart disease conferred an approximate 20% increase in the risk of MARCE for individuals with HFpEF after accounting for patient characteristics and comorbidities,” Rahimi and colleagues wrote. “The high prevalence of ischemia within the HFpEF population, as well as its association with increased risk of MARCE, suggest the need to create specific interventions for this subpopulation.”