Abstract 11440: Subclinical Cardiovascular and Non-Cardiovascular Risk Factors for Heart Failure with Preserved and Reduced Ejection Fraction in Black Americans: The Jackson Heart Study

Abstract

Introduction: Heart failure (HF) disproportionately burdens Black Americans. The contributions of impairments in cardiovascular (CV) and non-cardiovascular (non-CV) function to incident HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction in this group remain unclear. Methods: Among 4,356 Black participants in the Jackson Heart Study (JHS) free of prevalent HF at visit 1 (2000-2004), multivariable Cox proportional hazard models were employed to assess the associations of measures of CV and non-CV organ function with incident HF, HFpEF, and HFrEF over a median follow-up of 13 years. Systems considered included: CV: left ventricular (LV) structure (mass index; LVMI), LV systolic function (LVEF), LV diastolic function (left atrial diameter; LAD), systemic arterial function (pulse pressure; PP); Non-CV: pulmonary function (percent predicted FEV1; ppFEV1), renal function (eGFR), body composition (waist circumference), and dysglycemia (hemoglobin A1c; HbA1c). Model covariates included age, sex, hypertension, diabetes, smoking status, and coronary disease history. Results: Average age was 54±13 years and 64% were women. Over median 13 (IQR 12-14) years follow-up, incident HF occurred in 315 participants (152 HFpEF, 134 HFrEF, 29 unknown LVEF). In multivariable models incorporating measures reflecting each organ system, significant predictors of incident HFpEF included greater LAD, higher PP, lower ppFEV1, lower eGFR, larger waist circumference, and higher HbA1c (Figure). Predictors of incident HFrEF included greater LVMI, lower LVEF, and lower eGFR. eGFR was the only independent predictor of both HFpEF and HFrEF. Conclusion: Subclinical impairments in CV and non-CV organ function differentially associate with risk of incident HFpEF and HFrEF among Black Americans. These findings support partially distinct mechanisms underlying HFrEF and HFpEF, and a greater contribution of multisystem non-cardiac impairments to HFpEF in particular.