Prevalence, risk factors, treatment of heart failure and associated cardiovascular and non-cardiovascular outcomes

Abstract

Heart failure (HF) is the major public health challenge, affecting approximate 64 million population globally. The ageing demographics, along with increasing prevalence of antecedents e.g. hypertension, diabetes, coronary artery disease (CAD), and obesity are driving the epidemic of HF globally. The improvement of HF management has further extended the longevity and increased the clinical relevance of both cardiovascular and non-cardiovascular morbidity and mortality in patients with HF. This thesis consists of 9 chapters. Chapter 1 provided an overview, including a brief introduction of the prevalence, risk factors, managements of HF, and the general methods used in this thesis. Chapter 2 investigated the prevalence and prognosis of tricuspid regurgitation (TR) severity in 2014 patients with HF with preserved ejection fraction (HFpEF). It was demonstrated that the prevalence of moderate or severe TR was common and increased from stage B to C HFpEF (8 to 16%). Moreover, moderate/severe TR was significantly associated with higher risks of all‐cause mortality, HF hospitalization and cardiovascular death (CVD). II Chapter 3 and chapter 4 assessed the incidence, risk factors, clinical prognosis, and management of dementia among HF patients. New-onset dementia occurred in 11.0% HF patients, including its sub-types: Alzheimer’s disease (AD, 26.8%); vascular dementia (VD, 18.1%) and unspecified dementia (55.1%). Independent predictors included older age, female sex, Parkinson’s disease, peripheral vascular disease, stroke, anaemia, and hypertension. Dementia per se was independently associated with increased risk of all-cause mortality. Furthermore, it was found that statin users was associated with a 20% lower risk of all-cause dementia, 28% lower of AD, 18% lower of VD, and 20% lower of unspecified dementia compared with statin non-users. Chapter 5 evaluated the effects of statins use in reducing cancer among 87102 HF patients. The results demonstrated that incident cancer was prevalent (12.7%) in HF; notably, statin was associated with 16% reduced risk of cancer and 26% lower risk of cancer-related mortality. Chapter 6 investigated the association between serum triglyceride (TG) levels and cardiovascular outcomes among 127,124 patients with HF. It was showed that TG levels exhibited U-shaped associations with all-cause mortality and CVD. Notably, a higher TG level was associated with increased risks of Atherosclerotic cardiovascular disease (ASCVD) related admission or death, whereas a lower TG level was predominantly associated with higher risks of HF-related readmission or death. Chapter 7 evaluated the association between variability in glycated hemoglobin A1c (HbA1c) and cardiovascular events among 65950 patients. HbA1c variability was defined by average successive variability (ASV) or SD of all measurements of HbA1c. The results showed that HbA1c variability was significantly associated III with the risks of rehospitalization and all-cause mortality in HF patients regardless of diabetes status. Interestingly, the association was stronger in HF patients without diabetes. Chapter 8 investigated the effects of both short-term and long-term paracetamol use on cardiovascular events among HF patients. It was demonstrated that the use of paracetamol among patients with HF was prevalent, and was associated with higher risks of incident cardiovascular events, while its impact on long-term mortality remained neutral.