Risk factor-based subphenotyping of heart failure in the community

Autoři: Charlotte Andersson aff001;  Asya Lyass aff001;  Vanessa Xanthakis aff001;  Martin G. Larson aff001;  Gary F. Mitchell aff006;  Susan Cheng aff001;  Ramachandran S. Vasan aff001
Působiště autorů: The Framingham Heart Study, Framingham, Massachusetts, United States of America aff001;  Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark aff002;  Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America aff003;  Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America aff004;  Sections of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America aff005;  Cardiovascular Engineering, Inc., Norwood, Massachusetts, United States of America aff006;  Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America aff007;  Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222886



Heart failure (HF) is a heterogeneous clinical syndrome with varying prognosis. Subphenotyping of HF is a research priority to advance our understanding of the syndrome. We formulated a subphenotyping schema and compared long-term mortality risk among the HF subphenotypes in the community-based Framingham Study.

Methods and results

In hierarchical order, we grouped participants with new-onset HF (stratified by HF with reduced [HFrEF] vs. preserved ejection fraction [HFpEF]) according to the presence of: (1) coronary heart disease (CHD), (2) metabolic syndrome (MetS), (3) hypertension, and (4) ‘other’ causes. Age at HF onset was lowest in people with the MetS (mean 76 vs. 77 years for HFrEF and HFpEF, respectively) and highest in those with hypertension only (mean 82 and 85 years for HFrEF and HFpEF, respectively). For HFrEF, 10-year cumulative mortality and hazards ratios [HR] were 87% for CHD (n = 219; referent group), 88% for MetS (n = 105; HR 0.95 [95% CI 0.73–1.23]), 82% for hypertension (n = 104; HR 0.71 [0.55–0.91]), and 78% for other (n = 37; HR 0.81 [0.55–1.19]). Corresponding 10-year cumulative mortality and HR data for HFpEF were: 85% for CHD (n = 84; referent), 83% for MetS (n = 118; HR 0.98 [0.72–1.33]), 81% for hypertension (n = 127; HR 0.71 [0.52–0.95]), and 76% for other (n = 43; HR 0.76 [0.50–1.14]). In a sample without overt heart failure (n = 5536), several echocardiographic and vascular indices showed graded worsening of age- and sex adjusted-values among those having CHD, MetS, hypertension, or obesity, compared with individuals not having these risk factors.


HF subphenotypes characterized by the presence of CHD or metabolic syndrome present at a younger age and are marked by greater mortality risk. The clinical utility of the proposed subphenotyping schema warrants further research.

Klíčová slova:

Blood pressure – Cardiovascular diseases – Coronary heart disease – Death rates – Heart failure – Hypertension – Medical risk factors – Metabolic syndrome


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2019 Číslo 10
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