Abstract MP21: Heart Failure Risk Associated With Optimal Levels of Modifiable HF Risk Factors: The Atherosclerosis Risk in Communities Study (ARIC)
Bibliographic record
Abstract
Background: Several heart failure (HF) risk factors, including hypertension, diabetes mellitus, obesity, and physical activity, are well described. However, the degree to which optimization of these modifiable risk factors might impact the incidence of HF is not yet fully defined. Hypothesis: We hypothesized more optimal control of major modifiable HF risk factors is associated with progressively lower HF risk. Methods: We performed a prospective analysis of 13,534 ARIC participants (mean age 57, 55% female), examining HF risk associations of different cutpoints of glycemia (HbA1c), systolic blood pressure (SBP), body mass index (BMI) and physical activity (assessed at Visit 2 [1990-92], except for physical activity assessed at Visit 1 (1987-89]). Optimal risk factor control was defined as HbA1c < 7%, SBP < 120 mmHg, BMI 18.5-25 kg/m 2 , and AHA-recommended activity levels. Severely uncontrolled risk factors were defined as HbA1c > 8%, SBP > 160 mmHg, BMI > 35 kg/m 2 and no exercise physical activity. Intermediate values were considered mild to moderately uncontrolled. Cox models simultaneously including all risk factors were constructed to assess associations of risk factor levels with incident HF (by discharge codes) after Visit 2 through 2016. Results: There were 2,827 HF events over a median 24 years of follow-up. Risk gradations were seen across categorizations of each risk factor (Table). In the full model, relative to optimal control, HRs were 2.06 for BMI ≥ 35 kg/m 2 , 1.16 for poor physical activity, 2.31 for HbA1c > 8% and 1.80 for SBP ≥ 160 mmHg. No risk gradient was seen from SBP < 120 to 140 mmHg among hypertensives. Incidence rates (per 1000 PYs) were 7.9 for all optimally controlled risk factors, 14.5 for 3-4 mild to moderately uncontrolled risk factors and 39.5 for 3-4 severely uncontrolled risk factors. Conclusion: Optimal control of modifiable risk factors is strongly linked to lower HF risk. Our findings suggest prioritizing optimization of existing risk factors may be central to successful strategies to prevent HF onset.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".