Author + information
- Received June 19, 2017
- Revision received July 31, 2017
- Accepted August 8, 2017
- Published online January 1, 2018.
- Ramachandran S. Vasan, MDa,b,∗ (, )
- Vanessa Xanthakis, PhDa,b,
- Asya Lyass, PhDa,
- Charlotte Andersson, MD, PhDc,
- Connie Tsao, MDa,d,
- Susan Cheng, MDa,e,
- Jayashri Aragam, MDe,f,
- Emelia J. Benjamin, MDa,b and
- Martin G. Larson, ScDa,b
- aBoston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
- bDepartments of Medicine, Biostatistics and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
- cThe Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- dDepartment of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- eDepartment of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- fDepartment of Medicine, Division of Cardiology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ramachandran S. Vasan, The Framingham Heart Study, 73 Mount Wayte Avenue, Suite No. 2, Framingham, Massachusetts 01702.
Objectives The purpose of this study was to describe the temporal trends in prevalence of left ventricular systolic dysfunction (LVSD) in individuals without and with heart failure (HF) in the community over a 3-decade period of observation.
Background Temporal trends in the prevalence and management of major risk factors may affect the epidemiology of HF.
Methods We compared the frequency, correlates, and prognosis of LVSD (left ventricular ejection fraction [LVEF] <50%) among Framingham Study participants without and with clinical HF in 3 decades (1985 to 1994, 1995 to 2004, and 2005 to 2014).
Results Among participants without HF (12,857 person-observations, mean age 53 years, 56% women), the prevalence of LVSD on echocardiography decreased (3.38% in 1985 to 1994 vs. 2.2% in 2005 to 2014; p < 0.0001), whereas mean LVEF increased (65% vs. 68%; p < 0.001). The elevated risk associated with LVSD (∼2- to 4-fold risk of HF or death) remained unchanged over time. Among participants with new-onset HF (n = 894, mean age 75 years, 52% women), the frequency of heart failure with preserved ejection fraction (HFpEF) increased (preserved LVEF ≥50%: 41.0% in 1985 to 1994 vs. 56.17% in 2005 to 2014; p < 0.001) and heart failure with reduced ejection fraction (HFrEF) decreased (reduced LVEF <40%: 44.10% vs. 31.06%; p = 0.002), whereas heart failure with midrange LVEF remained unchanged (LVEF 40% to <50%: 14.90% vs. 12.77%; p = 0.66). Cardiovascular mortality associated with HFrEF declined across decades (hazard ratio: 0.61; 95% confidence interval: 0.39 to 0.97), but remained unchanged for heart failure with midrange LVEF and HFpEF. Approximately 47% of the observed increase in LVEF among those without HF and 75% of the rising proportion of HFpEF across decades was attributable to trends in risk factors, especially a decline in the prevalence of coronary heart disease among those with HF.
Conclusions The profile of HF in the community has changed in recent decades, with a lower prevalence of LVSD and an increased frequency of HFpEF, presumably due to concomitant risk factor trends.
This work was supported by the National Heart, Lung, and Blood Institute contracts NO1-HC-25195 and HHSN268201500001I (both to Dr. Vasan); National Institutes of Health/National Heart, Lung, and Blood Institute grants K23HL118529 (to Dr. Tsao), R01-HL131532 and R01-HL134168 (to Dr. Cheng), and R01HL080124 (to Dr. Vasan); Harvard Medical School Fellowship (to Dr. Tsao); National Institute of Health grants 1R01HL128914 and 2R01 HL092577 (to Dr. Benjamin); and the Evans Scholar award and Jay and Louise Coffman endowment, Department of Medicine, Boston University School of Medicine (to Dr. Vasan). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 19, 2017.
- Revision received July 31, 2017.
- Accepted August 8, 2017.
- 2018 American College of Cardiology Foundation