Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease.
Background: Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk o...
| Published in: | Circulation Vol. 139; no. 16; pp. 1889 - 1900 |
|---|---|
| Main Authors: | , , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Lippincott Williams & Wilkins
4/16/2019
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139031655&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139031655 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00097322 1FV jtl: Circulation issn: 00097322 maglogo: N pubinfo: dt: 4/16/2019 vid: 139 iid: 16 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 139031655 139031655 NLM30813762 139031655 10.1161/CIRCULATIONAHA.118.037064 NLM30813762 139031655 ppf: 1889 ppct: 11 formats: tig: atl: Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease. aug: au: Saha, Priyanka Potiny, Praneetha Rigdon, Joseph Morello, Melissa Tcheandjieu, Catherine Romfh, Anitra Fernandes, Susan M. McElhinney, Doff B. Bernstein, Daniel Lui, George K. Shaw, Gary M. Ingelsson, Erik Priest, James R. affil: Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA. sug: subj: Heart Failure Epidemiology Acute Coronary Syndrome Epidemiology Heart Defects, Congenital Epidemiology United States Cox Proportional Hazards Model Incidence Retrospective Design Male Middle Age Human Algorithms Risk Factors Adult Female Validation Studies Comparative Studies Evaluation Research Multicenter Studies Middle Aged: 45-64 years Adult: 19-44 years Male Female ab: Background: Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors.Methods: A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank.Results: We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors.Conclusions: Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|