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01-12-2021 | Heart Failure | Research article

Modification effect of ideal cardiovascular health metrics on genetic association with incident heart failure in the China Kadoorie Biobank and the UK Biobank

Authors: Ruotong Yang, Jun Lv, Canqing Yu, Yu Guo, Pei Pei, Ninghao Huang, Ling Yang, Iona Y. Millwood, Robin G. Walters, Yiping Chen, Huaidong Du, Ran Tao, Junshi Chen, Zhengming Chen, Robert Clarke, Tao Huang, Liming Li, on behalf of the China Kadoorie Biobank Collaborative Group

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

Both genetic and cardiovascular factors contribute to the risk of developing heart failure (HF), but whether idea cardiovascular health metrics (ICVHMs) offset the genetic association with incident HF remains unclear.

Objectives

To investigate the genetic association with incident HF as well as the modification effect of ICVHMs on such genetic association in Chinese and British populations.

Methods

An ICVHMs based on smoking, drinking, physical activity, diets, body mass index, waist circumference, blood pressure, blood glucose, and blood lipids, and a polygenic risk score (PRS) for HF were constructed in the China Kadoorie Biobank (CKB) of 96,014 participants and UK Biobank (UKB) of 335,782 participants which were free from HF and severe chronic diseases at baseline.

Results

During the median follow-up of 11.38 and 8.73 years, 1451 and 3169 incident HF events were documented in CKB and UKB, respectively. HF risk increased monotonically with the increase of PRS per standard deviation (CKB: hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07, 1.32; UKB: 1.07; 1.03, 1.11; P for trend < 0.001). Each point increase in ICVHMs was associated with 15% and 20% lower risk of incident HF in CKB (0.85; 0.81, 0.90) and UKB (0.80; 0.77, 0.82), respectively. Compared with unfavorable ICVHMs, favorable ICVHMs was associated with a lower HF risk, with 0.71 (0.44, 1.15), 0.41 (0.22, 0.77), and 0.48 (0.30, 0.77) in the low, intermediate, and high genetic risk in CKB and 0.34 (0.26, 0.44), 0.32 (0.25, 0.41), and 0.37 (0.28, 0.47) in UKB (P for multiplicative interaction > 0.05). Participants with low genetic risk and favorable ICVHMs, as compared with high genetic risk and unfavorable ICVHMs, had 56~72% lower risk of HF (CKB 0.44; 0.28, 0.70; UKB 0.28; 0.22, 0.37). No additive interaction between PRS and ICVHMs was observed (relative excess risk due to interaction was 0.05 [−0.22, 0.33] in CKB and 0.04 [−0.14, 0.22] in UKB).

Conclusions

In CKB and UKB, genetic risk and ICVHMs were independently associated with the risk of incident HF, which suggested that adherence to favorable cardiovascular health status was associated with a lower HF risk among participants with all gradients of genetic risk.

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GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602. https://doi.org/10.1016/s0140-6736(16)31678-6.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. ESC Heart Fail. 2016;18(8):891–975. https://doi.org/10.1002/ejhf.592.CrossRef

Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, et al. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol. 2019;11:231–44. https://doi.org/10.2147/clep.S170873.CrossRefPubMedPubMedCentral

Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14(10):591–602. https://doi.org/10.1038/nrcardio.2017.65.CrossRefPubMed

Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. https://doi.org/10.1001/jama.2009.1062.CrossRefPubMedPubMedCentral

Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mähönen M, Katzmarzyk PT, et al. Lifestyle factors in relation to heart failure among Finnish men and women. Circ Heart Fail. 2011;4(5):607–12. https://doi.org/10.1161/circheartfailure.111.962589.CrossRefPubMed

Del Gobbo LC, Kalantarian S, Imamura F, Lemaitre R, Siscovick DS, Psaty BM, et al. Contribution of major lifestyle risk factors for incident heart failure in older adults: the Cardiovascular Health Study. JACC Heart Fail. 2015;3(7):520–8. https://doi.org/10.1016/j.jchf.2015.02.009.CrossRefPubMedPubMedCentral

Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mähönen M, Katzmarzyk PT, et al. Healthy lifestyle status, antihypertensive treatment and the risk of heart failure among Finnish men and women. J Hypertens. 2013;31(11):2158–64; discussion 64. https://doi.org/10.1097/HJH.0b013e328364136d.CrossRefPubMed

Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, et al. Healthy lifestyle and decreasing risk of heart failure in women: the Women’s Health Initiative observational study. J Am Coll Cardiol. 2014;64(17):1777–85. https://doi.org/10.1016/j.jacc.2014.07.981.CrossRefPubMedPubMedCentral

10.

Larsson SC, Tektonidis TG, Gigante B, Åkesson A, Wolk A. Healthy lifestyle and risk of heart failure: results from 2 prospective cohort studies. Circ Heart Fail. 2016;9(4):e002855. https://doi.org/10.1161/circheartfailure.115.002855.CrossRefPubMed

11.

Chatterjee NA, Chae CU, Kim E, Moorthy MV, Conen D, Sandhu RK, et al. Modifiable risk factors for incident heart failure in atrial dibrillation. JACC Heart Fail. 2017;5(8):552–60. https://doi.org/10.1016/j.jchf.2017.04.004.CrossRefPubMedPubMedCentral

12.

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586–613. https://doi.org/10.1161/circulationaha.109.192703.CrossRefPubMed

13.

Spahillari A, Talegawkar S, Correa A, Carr JJ, Terry JG, Lima J, et al. Ideal cardiovascular health, cardiovascular remodeling, and heart failure in blacks: the Jackson Heart Study. Circ Heart Fail. 2017;10(2). https://doi.org/10.1161/circheartfailure.116.003682.

14.

van Spaendonck-Zwarts KY, van Rijsingen IA, van den Berg MP, Lekanne Deprez RH, Post JG, van Mil AM, et al. Genetic analysis in 418 index patients with idiopathic dilated cardiomyopathy: overview of 10 years’ experience. Eur J Heart Fail. 2013;15(6):628–36. https://doi.org/10.1093/eurjhf/hft013.CrossRefPubMed

15.

Lee DS, Pencina MJ, Benjamin EJ, Wang TJ, Levy D, O'Donnell CJ, et al. Association of parental heart failure with risk of heart failure in offspring. N Engl J Med. 2006;355(2):138–47. https://doi.org/10.1056/NEJMoa052948.CrossRefPubMed

16.

Lindgren MP, Smith JG, Li X, Sundquist J, Sundquist K, Zöller B. Sibling risk of hospitalization for heart failure - a nationwide study. Int J Cardiol. 2016;223:379–84. https://doi.org/10.1016/j.ijcard.2016.08.067.CrossRefPubMed

17.

Lindgren MP, Smith JG, Li X, Sundquist J, Sundquist K, Zöller B. Familial mortality risks in patients with heart failure-a Swedish sibling study. J Am Heart Assoc. 2018;7(24):e010181. https://doi.org/10.1161/jaha.118.010181.CrossRefPubMedPubMedCentral

18.

Larson MG, Atwood LD, Benjamin EJ, Cupples LA, D'Agostino RB Sr, Fox CS, et al. Framingham Heart Study 100K project: genome-wide associations for cardiovascular disease outcomes. BMC Med Genet. 2007;8(Suppl 1):S5. https://doi.org/10.1186/1471-2350-8-s1-s5.CrossRefPubMedPubMedCentral

19.

Smith NL, Felix JF, Morrison AC, Demissie S, Glazer NL, Loehr LR, et al. Association of genome-wide variation with the risk of incident heart failure in adults of European and African ancestry: a prospective meta-analysis from the cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium. Circ Cardiovasc Genet. 2010;3(3):256–66. https://doi.org/10.1161/circgenetics.109.895763.CrossRefPubMedPubMedCentral

20.

Aragam KG, Chaffin M, Levinson RT, McDermott G, Choi SH, Shoemaker MB, et al. Phenotypic refinement of heart failure in a national biobank facilitates genetic discovery. Circulation. 2018. https://doi.org/10.1161/circulationaha.118.035774.

21.

Shah S, Henry A, Roselli C, Lin H, Sveinbjörnsson G, Fatemifar G, et al. Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure. Nat Commun. 2020;11(1):163. https://doi.org/10.1038/s41467-019-13690-5.CrossRefPubMedPubMedCentral

22.

Khawaja O, Kotler G, Gaziano JM, Djoussé L. Usefulness of desirable lifestyle factors to attenuate the risk of heart failure among offspring whose parents had myocardial infarction before age 55 years. Am J Cardiol. 2012;110(3):326–30. https://doi.org/10.1016/j.amjcard.2012.03.028.CrossRefPubMedPubMedCentral

23.

Perrot N, Verbeek R, Sandhu M, Boekholdt SM, Hovingh GK, Wareham NJ, et al. Ideal cardiovascular health influences cardiovascular disease risk associated with high lipoprotein(a) levels and genotype: the EPIC-Norfolk prospective population study. Atherosclerosis. 2017;256:47–52. https://doi.org/10.1016/j.atherosclerosis.2016.11.010.CrossRefPubMedPubMedCentral

24.

Pazoki R, Dehghan A, Evangelou E, Warren H, Gao H, Caulfield M, et al. Genetic predisposition to high blood pressure and lifestyle factors: associations with midlife blood pressure levels and cardiovascular events. Circulation. 2018;137(7):653–61. https://doi.org/10.1161/circulationaha.117.030898.CrossRefPubMed

25.

Said MA, Verweij N, van der Harst P. Associations of combined genetic and lifestyle risks with incident cardiovascular disease and diabetes in the UK Biobank Study. JAMA Cardiol. 2018;3(8):693–702. https://doi.org/10.1001/jamacardio.2018.1717.CrossRefPubMedPubMedCentral

26.

Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015;12(3):e1001779. https://doi.org/10.1371/journal.pmed.1001779.CrossRefPubMedPubMedCentral

27.

Chen Z, Lee L, Chen J, Collins R, Wu F, Guo Y, et al. Cohort profile: the Kadoorie Study of Chronic Disease in China (KSCDC). Int J Epidemiol. 2005;34(6):1243–9. https://doi.org/10.1093/ije/dyi174.CrossRefPubMed

28.

Chen Z, Chen J, Collins R, Guo Y, Peto R, Wu F, et al. China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol. 2011;40(6):1652–66. https://doi.org/10.1093/ije/dyr120.CrossRefPubMedPubMedCentral

29.

Yang YX, Wang XL, Leong PM, Zhang HM, Yang XG, Kong LZ, et al. New Chinese dietary guidelines: healthy eating patterns and food-based dietary recommendations. Asia Pac J Clin Nutr. 2018;27(4):908–13. https://doi.org/10.6133/apjcn.072018.03.CrossRefPubMed

30.

Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960-84. 2013. https://doi.org/10.1016/j.jacc.2013.11.003.

31.

Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, et al. Adherence to healthy lifestyle and cardiovascular diseases in the Chinese population. J Am Coll Cardiol. 2017;69(9):1116–25. https://doi.org/10.1016/j.jacc.2016.11.076.CrossRefPubMedPubMedCentral

32.

Han L, You D, Ma W, Astell-Burt T, Feng X, Duan S, et al. National trends in American Heart Association revised life’s simple 7 metrics associated with risk of mortality among US adults. JAMA Netw Open. 2019;2(10):e1913131. https://doi.org/10.1001/jamanetworkopen.2019.13131.CrossRefPubMedPubMedCentral

33.

Lourida I, Hannon E, Littlejohns TJ, Langa KM, Hyppönen E, Kuzma E, et al. Association of lifestyle and genetic risk with incidence of dementia. JAMA. 2019;322(5):430–7. https://doi.org/10.1001/jama.2019.9879.CrossRefPubMedPubMedCentral

34.

Andersson T, Alfredsson L, Källberg H, Zdravkovic S, Ahlbom A. Calculating measures of biological interaction. Eur J Epidemiol. 2005;20(7):575–9. https://doi.org/10.1007/s10654-005-7835-x.CrossRefPubMed

35.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128.CrossRefPubMed

36.

Cahill TJ, Ashrafian H, Watkins H. Genetic cardiomyopathies causing heart failure. Circ Res. 2013;113(6):660–75. https://doi.org/10.1161/circresaha.113.300282.CrossRefPubMed

37.

Nides M. Update on pharmacologic options for smoking cessation treatment. Am J Med. 2008;121(4 Suppl 1):S20–31. https://doi.org/10.1016/j.amjmed.2008.01.016.CrossRefPubMed

38.

Johnson HM, Gossett LK, Piper ME, Aeschlimann SE, Korcarz CE, Baker TB, et al. Effects of smoking and smoking cessation on endothelial function: 1-year outcomes from a randomized clinical trial. J Am Coll Cardiol. 2010;55(18):1988–95. https://doi.org/10.1016/j.jacc.2010.03.002.CrossRefPubMedPubMedCentral

39.

Schocken DD, Benjamin EJ, Fonarow GC, Krumholz HM, Levy D, Mensah GA, et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. 2008;117(19):2544–65. https://doi.org/10.1161/CIRCULATIONAHA.107.188965.CrossRefPubMed

40.

Schuler G, Adams V, Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. European heart journal. 2013;34(24):1790–9. https://doi.org/10.1093/eurheartj/eht111.CrossRefPubMed

41.

Djoussé L, Hunt SC, Eckfeldt JH, Arnett DK, Province MA, Ellison RC. Alcohol consumption and plasma atrial natriuretic peptide (from the HyperGEN study). Am J Cardiol. 2006;98(5):628–32. https://doi.org/10.1016/j.amjcard.2006.03.041.CrossRefPubMed

42.

Kenchaiah S, Gaziano JM, Vasan RS. Impact of obesity on the risk of heart failure and survival after the onset of heart failure. Med Clin North Am. 2004;88(5):1273–94. https://doi.org/10.1016/j.mcna.2004.04.011.CrossRefPubMed

43.

Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, O'Meara E, et al. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail. 2014;7(5):740–51. https://doi.org/10.1161/circheartfailure.114.001583.CrossRefPubMedPubMedCentral

Title: Modification effect of ideal cardiovascular health metrics on genetic association with incident heart failure in the China Kadoorie Biobank and the UK Biobank
Authors: Ruotong Yang
Jun Lv
Canqing Yu
Yu Guo
Pei Pei
Ninghao Huang
Ling Yang
Iona Y. Millwood
Robin G. Walters
Yiping Chen
Huaidong Du
Ran Tao
Junshi Chen
Zhengming Chen
Robert Clarke
Tao Huang
Liming Li
on behalf of the China Kadoorie Biobank Collaborative Group
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Heart Failure
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02122-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Modification effect of ideal cardiovascular health metrics on genetic association with incident heart failure in the China Kadoorie Biobank and the UK Biobank

Abstract

Background

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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