The online version of this article (doi:10.1186/1471-2261-14-61) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
RH conceived the manuscript, interpreted the data and wrote the manuscript; FB analyzed the data; JW, GG, THL, TO, SHJ, XF acquired the data and provided critical revision of the manuscript; KZ, SK provided critical revision of the manuscript and MW oversaw the statistical analysis and provided critical revision of the manuscript. All authors read and approved the final manuscript.
Most of what is known regarding the epidemiology of mortality from heart failure (HF) comes from studies within Western populations with few data available from the Asia-Pacific region where the burden of heart failure is increasing.
Individual level data from 543694 (85% Asian; 36% female) participants from 32 cohorts in the Asia Pacific Cohort Studies Collaboration were included in the analysis. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality from HF were estimated separately for Asians and non-Asians for a quintet of cardiovascular risk factors: systolic blood pressure, diabetes, body mass index, cigarette smoking and total cholesterol. All analyses were stratified by sex and study.
During 3,793,229 person years of follow-up there were 614 HF deaths (80% Asian). The positive associations between elevated blood pressure, obesity, and cigarette smoking were consistent for Asians and non-Asians. There was evidence to indicate that diabetes was a weaker risk factor for death from HF for Asians compared with non-Asians: HR 1.26 (95% CI: 0.74-2.13) versus 3.04 (95% CI 1.76-5.25) respectively; p for interaction = 0.022. Additional adjustment for covariates did not materially change the overall associations. There was no good evidence to indicate that total cholesterol was a risk factor for HF mortality in either population.
Most traditional cardiovascular risk factors including elevated blood pressure, obesity and cigarette smoking appear to operate similarly to increase the risk of death from HF in Asians and non-Asians populations alike.
Additional file 1: WebFigure 1: Hazard ratios for fatal heart failure associated with a 10 mmHg increment in systolic blood pressure, adjusted for age, smoking, body mass index, diabetes, and regression dilution bias and stratified by sex and study in the Asia Pacific Cohort Studies Collaboration, both by subgroup (male versus female; Asia versus Australia; < 75 yrs vs> 75 yrs) and overall. Bars show 95% confidence intervals. The vertical dimension of the diamond indicates the overall estimate and the horizontal dimension indicates the 95% confidence interval. WebFigure 2. Hazard ratios for fatal heart failure associated with cigarette smoking (ever versus never) adjusted for age, systolic blood pressure, body mass index and stratified by sex and study in the Asia Pacific Cohort Studies Collaboration. Conventions as in WebFigure 1. WebFigure 3. Hazard ratios for fatal heart failure associated with diabetes (yes versus no) adjusted for age, systolic blood pressure, body mass index, cigarette smoking, regression dilution bias and stratified by sex and study in the Asia Pacific Cohort Studies Collaboration. Conventions as in WebFigure 1. WebFigure 4. Hazard ratios for fatal heart failure associated with 1 mmol/L increment in total cholesterol (multiply by 38.7 to obtain mg/dL) adjusted for age, systolic blood pressure, body mass index, cigarette smoking, regression dilution bias and stratified by sex and study in the Asia Pacific Cohort Studies Collaboration. Conventions as in WebFigure 1. WebTable 1. Associations between risk factors and mortality from heart failure in those with and without a history of cardiovascular disease at study baseline. (DOCX 166 KB)
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- A comparison of risk factors for mortality from heart failure in Asian and non-Asian populations: An overview of individual participant data from 32 prospective cohorts from the Asia-Pacific Region
Rachel R Huxley
Tai Hing Lam
Sun Ha Jee
Asia Pacific Cohort Studies Collaboration
- BioMed Central
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