PMID- 25710785 OWN - NLM STAT- MEDLINE DCOM- 20160212 LR - 20201231 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 184 DP - 2015 Apr 1 TI - Reverse epidemiology in different stages of heart failure. PG - 216-224 LID - S0167-5273(15)00126-6 [pii] LID - 10.1016/j.ijcard.2015.02.009 [doi] AB - BACKGROUND: In heart failure (HF), traditional cardiovascular risk factors (RF) as body mass index (BMI), total cholesterol (TC) and systolic blood pressure (SBP) are associated with better survival. It is unknown at which time point along the disease continuum the adverse impact of these RF ceases and may 'start to reverse'. We analyzed the distribution of RF and their association with survival across HF stages. METHODS: We pooled data from four cohort studies from the German Competence Network HF. Employing ACC/AHA-criteria, patients were allocated to stage A (n=218), B (n=1324), C1 (i.e., New York Heart Association [NYHA] classes I & II; n=1134), and C2+D (NYHA III & IV; n=639). RESULTS: With increasing HF severity median age increased (63/67/67/70 years), whereas the proportion of females (56/52/37/35%), median BMI (26.1/28.8/27.7/26.6 kg/m(2)), TC (212/204/191/172 mg/dl), and SBP (140/148/130/120 mmHg) decreased (P<0.001 for trend for all). In the total cohort, higher levels of all RF were associated with better survival, even after extensive adjustment for multiple confounders. If analyses were stratified, however, a higher RF burden predicted better survival only in clinically symptomatic patients: hazard ratio (HR) per +2 kg/m(2) BMI 0.91 (95% confidence interval 0.88; 0.95); per +10 mg/dl TC 0.93 (0.92; 0.95); per +5 mmHg SBP 0.94 (0.92; 0.95). CONCLUSION: In this well-characterized sample of patients representing the entire HF continuum, reverse associations were only consistently observed in symptomatic HF stages. Our data indicate that the phenomenon of a "reverse epidemiology" in HF is subject to significant selection bias in less advanced disease. CI - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Guder, G AU - Guder G AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. FAU - Gelbrich, G AU - Gelbrich G AD - Institute of Clinical Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany; Clinical Trial Center Wurzburg, University Hospital Wurzburg, Wurzburg, Germany. FAU - Edelmann, F AU - Edelmann F AD - Department of Cardiology, University Hospital of Gottingen, Gottingen, Germany; Department of Internal Medicine - Cardiology, Charite University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany. FAU - Wachter, R AU - Wachter R AD - Department of Cardiology, University Hospital of Gottingen, Gottingen, Germany. FAU - Pieske, B AU - Pieske B AD - Department of Internal Medicine - Cardiology, Charite University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany; Deutsches Herzzentrum, Berlin, Germany. FAU - Pankuweit, S AU - Pankuweit S AD - Department of Cardiology, University Hospital Marburg, Marburg, Germany. FAU - Maisch, B AU - Maisch B AD - Department of Cardiology, University Hospital Marburg, Marburg, Germany. FAU - Prettin, C AU - Prettin C AD - Clinical Trial Centre Leipzig - KKS, University of Leipzig, Leipzig, Germany. FAU - Brenner, S AU - Brenner S AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. FAU - Morbach, C AU - Morbach C AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. FAU - Berliner, D AU - Berliner D AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany; Department of Cardiology, Hannover Medical School, Hannover, Germany. FAU - Deubner, N AU - Deubner N AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany; Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany. FAU - Ertl, G AU - Ertl G AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. FAU - Angermann, C E AU - Angermann CE AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. FAU - Stork, S AU - Stork S AD - Department of Medicine I - Cardiology, University of Wurzburg, Comprehensive Heart Failure Center & University Hospital Wurzburg, Wurzburg, Germany. Electronic address: stoerk_s@ukw.de. CN - Competence Network Heart Failure Germany LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20150210 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 SB - IM CIN - Int J Cardiol. 2015 Jun 1;188:54-5. PMID: 25885751 CIN - Int J Cardiol. 2015 Jul 15;191:48-9. PMID: 25965596 MH - Aged MH - Cohort Studies MH - *Disease Progression MH - Female MH - Follow-Up Studies MH - Heart Failure/*diagnosis/*epidemiology MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies OTO - NOTNLM OT - AHA/ACC stages of heart failure OT - Prognosis OT - Reverse epidemiology EDAT- 2015/02/25 06:00 MHDA- 2016/02/13 06:00 CRDT- 2015/02/25 06:00 PHST- 2014/11/07 00:00 [received] PHST- 2015/01/29 00:00 [revised] PHST- 2015/02/08 00:00 [accepted] PHST- 2015/02/25 06:00 [entrez] PHST- 2015/02/25 06:00 [pubmed] PHST- 2016/02/13 06:00 [medline] AID - S0167-5273(15)00126-6 [pii] AID - 10.1016/j.ijcard.2015.02.009 [doi] PST - ppublish SO - Int J Cardiol. 2015 Apr 1;184:216-224. doi: 10.1016/j.ijcard.2015.02.009. Epub 2015 Feb 10.