Abstract 4372137: Cardiometabolic Risk Factor Control in the Progression from Pre–Heart Failure to Clinical Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Pre–heart failure (pre-HF) is associated with a significantly increased risk of progression to clinical heart failure (HF). However, the independent and collective associations of lifestyle and cardiometabolic risk factor control on the risk of progression from pre-HF to clinical HF have not yet been fully characterized. Methods: We conducted a prospective analysis of ARIC Visit 5 participants (2011–2013) with pre-HF and no baseline HF or atherosclerotic cardiovascular disease. Pre-HF was defined by the presence of elevated cardiac biomarkers—high-sensitivity cardiac troponin T and/or I above the 99th percentile and/or NT-proBNP ≥125 pg/mL—and/or abnormal echocardiographic findings. We modeled lifestyle factors (physical activity and diet per AHA’s Life’s Simple 7) and cardiometabolic risk factor control (diabetes, hypertension, obesity and chronic kidney disease) categorically and continuously (per 1-SD) and assessed their associations with incident clinical HF, using survival analysis and Cox regression. Results: A total of 2,781 participants (mean age of 76 years, 63% women and 19% Black adults) were included. Over a median follow-up of 9 years, 433 participants developed clinical HF. Most participants had less than ideal physical activity (51%) and diet (95%), while 83% had at least 1 uncontrolled cardiometabolic risk factor. Compared to respective reference groups, poor physical activity, uncontrolled diabetes, class II/III obesity, and chronic kidney disease were associated with HF risk (Table 1). When modeled per 1-SD, the strongest predictors of progression to clinical HF were lower estimated glomerular filtration rate (eGFR), higher HbA1C, and higher body mass index (BMI).We observed a progressive association between the number and severity of uncontrolled cardiometabolic risk factors and transition from pre-HF to HF, with the highest risk among those with ≥2 severely uncontrolled risk factors (Figure 1). Conclusion: Uncontrolled cardiometabolic risk factors are highly prevalent and potent predictors of progression from pre-HF to clinical HF. Optimization of risk factor control and proven HF prevention strategies addressing cardiometabolic kidney health may confer substantial clinical benefits in this high-risk pre-HF population.