Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study

Abstract

Background: The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States.

Methods and results: We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance.

Conclusions: Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.

Keywords: blood pressure; body mass index; heart failure; hypertension; risk factors.

Figure 1. Consort diagram

Out of 4195 participants without prevalent CHD with Life’s Simple 7 metrics measured at baseline, 1188 were included in our CMR analyses, and 3858 were followed for incident HF. “Incomplete HF information” refers to missing self-reported HF hospitalization or self-reported physician diagnosis of heart failure. CHD, Coronary Heart Disease; CMR, Cardiac Magnetic Resonance; HF, Heart Failure; JHS, Jackson Heart Study.

Figure 2. Survival curves for incident HF by Simple 7 score category

Kaplan-Meier survival curves for HF-free survival stratified by Simple 7 score 0–2, 3 and ≥ 4. In this analysis, incident HF was defined as either self-reported or formally adjudicated incident HF. 239 incident HF events occurred in 3858 participants.

Figure 3. CMR measures of cardiac remodeling, stratified by median age, sex and obesity

Data points represent least-squares means (obtained in adjusted linear models), with error bars representing standard error of the mean. P values for interaction between Simple 7 score category and each stratum are presented.