Risk of Stroke in Older Adults With Heart Failure

Elizabeth Bierbower, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Nayrana Griffith, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Venkatesh K. Raman, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Vijaywant Brar, Veterans Affairs Medical Center, Washington, District of Columbia; Louisiana State University, Shreveport, Louisiana.
Jeffrey Roseman, University of Alabama at Birmingham, Birmingham, Alabama.
Prakash Deedwania, Veterans Affairs Medical Center, Washington, District of Columbia; University of California, San Francisco, California.
Gregg C. Fonarow, University of California, Los Angeles, California.
Richard M. Allman, Veterans Affairs Medical Center, Washington, District of Columbia; University of Alabama at Birmingham, Birmingham, Alabama.
Charles Faselis, Veterans Affairs Medical Center, Washington, District of Columbia; George Washington University, Washington, District of Columbia; Uniformed Services University, Washington, District of Columbia.
Sijian Zhang, Veterans Affairs Medical Center, Washington, District of Columbia.
George Howard, University of Alabama at Birmingham, Birmingham, Alabama.
Ali Ahmed, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; George Washington University, Washington, District of Columbia. Electronic address: ali.ahmed@va.gov.
Phillip H. Lam, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; MedStar Heart and Vascular Institute, District of Columbia.

Document Type

Journal Article

Publication Date

12-10-2022

Journal

The American journal of cardiology

Volume

189

DOI

10.1016/j.amjcard.2022.11.015

Abstract

Heart failure (HF) is a risk factor for incident stroke. However, less is known about the independent nature of this association and to what extent various baseline characteristics may mediate this risk. Of the 5,795 community-dwelling adults aged ≥65 years in the Cardiovascular Health Study, 5,448 were free of baseline stroke, of whom 229 had baseline HF. We used a multivariable-adjusted Cox regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for centrally adjudicated incident stroke associated with HF. Participants had a mean age of 73 years, 58% were women, and 15% were African-American. During 23 years of follow-up, incident stroke occurred in 18.8% and 19.3% of those with and without HF, respectively, but the time to first stroke was shorter in those with HF (age-gender-race-adjusted HR 1.64, 95% CI 1.21 to 2.25). The association remained essentially unchanged after adjustments for tobacco, alcohol, and physical activity (HR 1.63, 95% CI 1.21 to 2.24), attenuated after adjustment for hypertension, atrial fibrillation, myocardial infarction, and diabetes mellitus (HR 1.26, 95% CI 0.92 to 1.72), and further attenuated after additional adjustment for 10 baseline functional and subclinical variables (HR 1.05, 95% CI 0.76 to 1.46). In conclusion, despite a similar 23-year stroke incidence, time to first stroke was shorter in older adults with HF than without. However, this extra risk appears to be mediated primarily by 4 cardiovascular diseases that are also risk factors for HF. These findings highlight the importance of the primary prevention of these HF risk factors to reduce the extra risk of stroke in HF.

Department

Medicine

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