Association of Parental Heart Failure with Risk of Heart Failure in Offspring

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Lee, Douglas S.
Pencina, Michael J.
Benjamin, Emelia J.
Wang, Thomas J.
Levy, Daniel
O’Donnell, Christopher J.
Nam, Byung-Ho
Larson, Martin G.
D’Agostino, Ralph B.
Vasan, Ramachandran S.
Lee, Douglas S. and Pencina, Michael J. and Benjamin, Emelia J. and Wang, Thomas J. and Levy, Daniel and O’Donnell, Christopher J. and Nam, Byung-Ho and Larson, Martin G. and D’Agostino, Ralph B. and Vasan, Ramachandran S. (2006) Association of Parental Heart Failure with Risk of Heart Failure in Offspring. The New England Journal of Medicine, 355 (2). pp. 138-147.
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.