Background: The association between heart failure in parents and the prevalence of left ventricular systolic dysfunction and the risk of heart failure in their offspring has not been investigated in a community-based ...Background: The association between heart failure in parents and the prevalence of left ventricular systolic dysfunction and the risk of heart failure in their offspring has not been investigated in a community-based setting. Methods: We examined the cross-sectional association of heart failure in parents with the prevalence of left ventricular systolic dysfunction, as well as left ventricular mass, internal dimensions, and wall thickness, in 1497 participants of the Framingham Offspring Study(mean age, 57 years; 819 women) who underwent routine echocardiography. We also investigated prospectively whether heart failure in parents increased the risk of heart failure in 2214 offspring(mean age, 44 years; 1150 women). Results: As compared with the 1039 participants whose parents did not have heart failure, the 458 participants in the cross-sectional cohort who had at least one parent with heart failure were more likely to have increased left ventricular mass(17.0 percent vs. 26.9 percent), left ventricular internal dimensions(18.6 percent vs. 23.4 percent), and left ventricular systolic dysfunction(3.1 percent vs. 5.7 percent); the multivariable-adjusted odds ratios were 1.35(95 percent confidence interval, 0.99 to 1.84), 1.29(95 percent confidence interval, 0.96 to 1.72), and 2.37(95 percent confidence interval, 1.22 to 4.61), respectively. In the longitudinal cohort, heart failure developed in 90 offspring during follow-up(mean length of follow-up, 20 years). The age-and sex-adjusted 10-year incidence rates of heart failure were 2.72 percent among offspring with a parent with heart failure, as compared with 1.62 percent among those without a parent with heart failure. This increase in risk persisted after multivariable adjustment(hazard ratio, 1.70; 95 percent confidence interval, 1.11 to 2.60). Conclusions: Heart failure in parents is associated with an increased prevalence of left ventricular systolic dysfunction cross-sectionally and an elevated risk of heart failure longitudinally. Our data emphasize the contribution of familial factors to the heart-failure burden in the community.展开更多
BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibi...BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibitors is also indicate d in these patients. However, life-threatening hyperkalemia can occur when thes e drugs are used together. METHODS: We conducted a population-based time-serie s analysis to examine trends in the rate of spironolactone prescriptions and the rate of hospitalization for hyperkalemia in ambulatory patients before and afte r the publication of RALES. We linked prescription-claims data and hospital-ad mission records for more than 1.3 million adults 66 years of age or older in Ont ario, Canada, for the period from 1994 through 2001. RESULTS: Among patients tre ated with ACE inhibitors who had recently been hospitalized for heart failure, t he spironolactone-prescription rate was 34 per 1000 patients in 1994, and it in creased immediately after the publication of RALES, to 149 per 1000 patients by late 2001 (P< 0.001). The rate of hospitalization for hyperkalemia rose from 2.4 per 1000 patients in 1994 to 11.0 per 1000 patients in 2001 (P< 0.001), and the associated mortality rose from 0.3 per 1000 to 2.0 per 1000 patients (P< 0.001) . As compared with expected numbers of events, there were 560(95 percent confide nce interval, 285 to 754) additional hyperkalemia-related hospitalizations and 73 (95 percent conf idence interval, 27 to 120) additional hospital deaths during 2001 among older p atients with heart failure who were treated with ACE inhibitors in Ontario. Publ ication of RALES was not associated with significant decreases in the rates of r eadmission for heart failure or death from all causes. CONCLUSIONS: The publicat ion of RALES was associated with abrupt increases in the rate of prescriptions f or spironolactone and in hyperkalemia- associated morbidity and mortality. Closer laboratory monitoring and more judi cious use of spironolactone may reduce the occurrence of this complication.展开更多
文摘Background: The association between heart failure in parents and the prevalence of left ventricular systolic dysfunction and the risk of heart failure in their offspring has not been investigated in a community-based setting. Methods: We examined the cross-sectional association of heart failure in parents with the prevalence of left ventricular systolic dysfunction, as well as left ventricular mass, internal dimensions, and wall thickness, in 1497 participants of the Framingham Offspring Study(mean age, 57 years; 819 women) who underwent routine echocardiography. We also investigated prospectively whether heart failure in parents increased the risk of heart failure in 2214 offspring(mean age, 44 years; 1150 women). Results: As compared with the 1039 participants whose parents did not have heart failure, the 458 participants in the cross-sectional cohort who had at least one parent with heart failure were more likely to have increased left ventricular mass(17.0 percent vs. 26.9 percent), left ventricular internal dimensions(18.6 percent vs. 23.4 percent), and left ventricular systolic dysfunction(3.1 percent vs. 5.7 percent); the multivariable-adjusted odds ratios were 1.35(95 percent confidence interval, 0.99 to 1.84), 1.29(95 percent confidence interval, 0.96 to 1.72), and 2.37(95 percent confidence interval, 1.22 to 4.61), respectively. In the longitudinal cohort, heart failure developed in 90 offspring during follow-up(mean length of follow-up, 20 years). The age-and sex-adjusted 10-year incidence rates of heart failure were 2.72 percent among offspring with a parent with heart failure, as compared with 1.62 percent among those without a parent with heart failure. This increase in risk persisted after multivariable adjustment(hazard ratio, 1.70; 95 percent confidence interval, 1.11 to 2.60). Conclusions: Heart failure in parents is associated with an increased prevalence of left ventricular systolic dysfunction cross-sectionally and an elevated risk of heart failure longitudinally. Our data emphasize the contribution of familial factors to the heart-failure burden in the community.
文摘BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibitors is also indicate d in these patients. However, life-threatening hyperkalemia can occur when thes e drugs are used together. METHODS: We conducted a population-based time-serie s analysis to examine trends in the rate of spironolactone prescriptions and the rate of hospitalization for hyperkalemia in ambulatory patients before and afte r the publication of RALES. We linked prescription-claims data and hospital-ad mission records for more than 1.3 million adults 66 years of age or older in Ont ario, Canada, for the period from 1994 through 2001. RESULTS: Among patients tre ated with ACE inhibitors who had recently been hospitalized for heart failure, t he spironolactone-prescription rate was 34 per 1000 patients in 1994, and it in creased immediately after the publication of RALES, to 149 per 1000 patients by late 2001 (P< 0.001). The rate of hospitalization for hyperkalemia rose from 2.4 per 1000 patients in 1994 to 11.0 per 1000 patients in 2001 (P< 0.001), and the associated mortality rose from 0.3 per 1000 to 2.0 per 1000 patients (P< 0.001) . As compared with expected numbers of events, there were 560(95 percent confide nce interval, 285 to 754) additional hyperkalemia-related hospitalizations and 73 (95 percent conf idence interval, 27 to 120) additional hospital deaths during 2001 among older p atients with heart failure who were treated with ACE inhibitors in Ontario. Publ ication of RALES was not associated with significant decreases in the rates of r eadmission for heart failure or death from all causes. CONCLUSIONS: The publicat ion of RALES was associated with abrupt increases in the rate of prescriptions f or spironolactone and in hyperkalemia- associated morbidity and mortality. Closer laboratory monitoring and more judi cious use of spironolactone may reduce the occurrence of this complication.
