Adults with congenital heart disease: the growing impact of acquired cardiovascular risk factors on late mortality.

BACKGROUND AND AIMS: With improved survival, adults with congenital heart disease (ACHD) increasingly face acquired cardiovascular risk factors; however, their impact on late mortality remains incompletely defined. This study aimed to evaluate the contribution of acquired cardiovascular risk factors to mortality in ACHD. METHODS: A total of 9826 ACHD patients (mean age 39.0 ± 16.4 years; 50.3% male) who attended our tertiary centre between 2000 and 2024 were retrospectively analysed. Clinical and demographic data were obtained from a prospectively maintained database. Cox proportional hazards models were used to assess associations between risk factors and all-cause mortality. RESULTS: During a median follow-up of 10.0 years (98 764 patient-years), 1371 patients died (mortality rate 1.39% per patient-year). In multivariable analysis, older age (hazard ratio [HR] 1.07 per year; P < .001), male sex (HR 1.30; P = .026), greater lesion complexity (HR 2.12; P < .001), coronary artery disease (HR 1.78; P = .005), sleep apnoea (HR 2.22; P < .001), depression (HR 1.45; P = .010), and current smoking (HR 1.67; P < .001) were independently associated with higher mortality, while higher income was associated with lower mortality risk. CONCLUSIONS: Both congenital lesion complexity and acquired comorbidities are associated with late mortality in ACHD. These data support the need for comprehensive, multidisciplinary management that incorporates timely modification of general cardiovascular and other risk factors alongside congenital heart disease-specific care.