Carotid Intima‐Media Thickness, Carotid Distensibility, and Incident Heart Failure in Older Men: The British Regional Heart Study

BACKGROUND: Carotid intima-media thickness (CIMT) and carotid distensibility are markers of arterial change; however, little is known of the association with incident heart failure (HF).We aimed to assess this. METHODS:This was a longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study.A total of 1631 men aged 71 to 92 years, without a diagnosis of HF at baseline, were included.Between 2010 and 2012, participants completed a questionnaire, underwent a physical examination, and provided a fasting blood sample.CIMT and carotid artery distension were measured, and carotid distensibility was calculated.Cox proportional hazards modeling was used to assess the multivariate-adjusted hazard ratios (HRs) of incident HF by quartiles of CIMT and distensibility, excluding men with prevalent myocardial infarction. RESULTS:The values used in the analysis were adjusted for age, social class, smoking, physical activity, alcohol status, body mass index, use of statins and antihypertensives, prevalent diabetes and stroke, pulse pressure, and presence of atrial arrhythmias.Lower carotid distensibility (bottom quartile) and higher CIMT (top quartile) were associated with increased risk of incident HF (HR, 2.55 [95% CI, 1.24-5.24];P=0.01; and HR, 2.20 [95% CI, 1.14-4.23];P=0.02, respectively).CIMT but not carotid distensibility was associated with incident myocardial infarction.The association between carotid distensibility and incident HF persisted after adjustment for incident myocardial infarction and CIMT (HR, 2.53 [95% CI, 1.23-5.22];P=0.01); however, the association between CIMT and incident HF was attenuated after this adjustment (HR, 1.64 [95% CI, 0.84-3.21];P=0.15).CONCLUSIONS: Lower carotid distensibility and higher CIMT were associated with an increased risk of incident HF, despite adjustment for incident myocardial infarction.Key Words: cardiovascular diseases carotid artery distensibility carotid intima-media thickness heart failure I n the United Kingdom, heart failure (HF) affects 920 000 people, with 200 000 new cases annually. 1Primarily a disease affecting older adults, at least 5% of people aged >75 years are affected with HF, with prevalence increasing with age to 15% in people aged >85 years. 2 It is the only cardiovascular disease (CVD) increasing in prevalence despite advances in medical care, likely due to HF being a final complication for several cardiac conditions that affect cardiac contractility. 3 Given the aging of many developed-country