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ABSTRACT: BACKGROUND: -An algorithm to classify heart failure (HF) endpoints inclusive of contemporary measures of biomarkers and echocardiography was recently proposed by an international expert panel. Our objective was to assess agreement of HF classification by this contemporaneous algorithm with that by a standardized physician reviewer panel, when applied to data abstracted from community-based hospital records. METHODS AND RESULTS: -During 2005-2007, all hospitalizations were identified from four U.S. communities under surveillance as part of the Atherosclerosis Risk in Communities (ARIC) study. Potential HF hospitalizations were sampled by ICD discharge codes and demographics from men and women aged 55 years and older. The HF classification algorithm was automated and applied to 2,729 (N=13,854 weighted hospitalizations) hospitalizations in which either BNP measures or ejection fraction were documented (mean age 75 years). There were 1,403 (54%, N=7,534 weighted) events classified as acute, decompensated HF (ADHF) by the automated algorithm, and 1,748 (68%, N=9,276 weighted) such events by the ARIC reviewer panel. The chance-corrected agreement between ADHF by physician reviewer panel and the automated algorithm was moderate (Kappa=0.39). Sensitivity and specificity of the automated algorithm with ARIC reviewer panel as the referent standard was 0.68 (95% CI, 0.67 - 0.69), and 0.75 (95% CI, 0.74 - 0.76), respectively. CONCLUSIONS: -Although the automated classification improved efficiency and decreased costs, its accuracy in classifying HF hospitalizations was modest compared to a standardized physician reviewer panel.
Circulation Heart Failure 05/2013; · 6.29 Impact Factor
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Rhea Powell,
Duncan Davidson,
Jasmin Divers,
Ani Manichaikul,
J Jeffrey Carr,
Robert Detrano,
Eric A Hoffman,
Rui Jiang,
Richard A Kronmal,
Kiang Liu,
Naresh M Punjabi, Eyal Shahar,
Karol E Watson,
Jerome I Rotter,
Kent D Taylor,
Stephen S Rich,
R Graham Barr
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ABSTRACT: BACKGROUND: Cigarette smoking is the major cause of chronic obstructive pulmonary disease and emphysema. Recent studies suggest that susceptibility to cigarette smoke may vary by race/ethnicity; however, they were generally small and relied on self-reported race/ethnicity. OBJECTIVE: To test the hypothesis that relationships of smoking to lung function and per cent emphysema differ by genetic ancestry and self-reported race/ethnicity among Caucasians, African-Americans, Hispanics and Chinese-Americans. DESIGN: Cross-sectional population-based study of adults age 45-84 years in the USA. MEASUREMENTS: Principal components of genetic ancestry and continental ancestry estimated from one million genome-wide single nucleotide polymorphisms; pack-years of smoking; spirometry measured for 3344 participants; and per cent emphysema on computed tomography for 8224 participants. RESULTS: The prevalence of ever-smoking was: Caucasians, 57.6%; African-Americans, 56.4%; Hispanics, 46.7%; and Chinese-Americans, 26.8%. Every 10 pack-years was associated with -0.73% (95% CI -0.90% to -0.56%) decrement in the forced expiratory volume in 1 s to forced vital capacity (FEV1 to FVC) and a 0.23% (95% CI 0.08% to 0.38%) increase in per cent emphysema. There was no evidence that relationships of pack-years to the FEV1 to FVC, airflow obstruction and per cent emphysema varied by genetic ancestry (all p>0.10), self-reported race/ethnicity (all p>0.10) or, among African-Americans, African ancestry. There were small differences in relationships of pack-years to the FEV1 among male Chinese-Americans and to the FEV1 to FVC ratio with African and Native American ancestry among male Hispanics only. CONCLUSIONS: In this large cohort, there was little to no evidence that the associations of smoking to lung function and per cent emphysema differed by genetic ancestry or self-reported race/ethnicity.
Thorax 04/2013; · 6.84 Impact Factor
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ABSTRACT: The cross-sectional study design is sometimes avoided by researchers or considered an undesired methodology. Possible reasons include incomplete understanding of the research design, fear of bias, and uncertainty about the measure of association. Using causal diagrams and certain premises, we compared a hypothetical cross-sectional study of the effect of a fertility drug on pregnancy with a hypothetical cohort study. A side-by-side analysis showed that both designs call for a tradeoff between information bias and variance and that neither offers immunity to sampling colliding bias (selection bias). Confounding bias does not discriminate between the two designs either. Uncertainty about the order of causation (ambiguous temporality) depends on the nature of the postulated cause and the measurement method. We conclude that a cross-sectional study is not inherently inferior to a cohort study. Rather than devaluing the cross-sectional design, threats of bias should be evaluated in the context of a concrete study, the causal question at hand, and a theoretical causal structure.
Clinical Epidemiology 01/2013; 5:57-65.
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ABSTRACT: Background: The relationship between stroke subtypes and physical activity is unclear. Methods: Using data from 13,069 men and women aged 45-64 years who participated in the Atherosclerosis Risk in Communities Study, physical activity was assessed by self-report using the Baecke questionnaire at baseline (1987-1989). The American Heart Association's ideal cardiovascular health guidelines served as a basis for the calculation of three physical activity categories: poor, intermediate, and ideal. Stroke and its subtypes were ascertained from physician review of medical records. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models. Results: During a median follow-up of 18.8 years, a total of 648 incident ischemic strokes occurred. Significant inverse associations were found between physical activity categories and total, total ischemic, and nonlacunar stroke in adjusted models (age, sex, race-center, education, cigarette-years). Compared with poor physical activity, the adjusted HR (95% CI) for ideal physical activity were 0.78 (0.62-0.97) for total, 0.76 (0.59-0.96) for total ischemic, 0.85 (0.51-1.40) for lacunar, 0.77 (0.47-1.27) for cardioembolic, and 0.71 (0.51-0.99) for nonlacunar stroke. Additional adjustments for waist-to-hip ratio, systolic blood pressure, antihypertensive medication, diabetes, left ventricular hypertrophy and laboratory parameters attenuated the HR. Further sex- and race-specific analyses revealed that the association was predominantly observed among males and among African-Americans. Conclusion: These data suggest a tendency toward a reduced risk of total, total ischemic, and nonlacunar stroke with higher levels of physical activity.
Neuroepidemiology 10/2012; 40(2):109-116. · 2.31 Impact Factor
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Sunil K Agarwal,
Lloyd E Chambless,
Christie M Ballantyne,
Brad Astor,
Alain G Bertoni,
Patricia P Chang,
Aaron R Folsom,
Max He,
Ron C Hoogeveen,
Hanyu Ni,
Pedro M Quibrera,
Wayne D Rosamond,
Stuart D Russell, Eyal Shahar,
Gerardo Heiss
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ABSTRACT: A simple and effective heart failure (HF) risk score would facilitate the primary prevention and early diagnosis of HF in general practice. We examined the external validity of existing HF risk scores, optimized a 10-year HF risk function, and examined the incremental value of several biomarkers, including N-terminal pro-brain natriuretic peptide.
During 15.5 years (210 102 person-years of follow-up), 1487 HF events were recorded among 13 555 members of the biethnic Atherosclerosis Risk in Communities (ARIC) Study cohort. The area under curve from the Framingham-published, Framingham-recalibrated, Health ABC HF recalibrated, and ARIC risk scores were 0.610, 0.762, 0.783, and 0.797, respectively. On addition of N-terminal pro-brain natriuretic peptide, the optimism-corrected area under curve of the ARIC HF risk score increased from 0.773 (95% CI, 0.753-0.787) to 0.805 (95% CI, 0.792-0.820). Inclusion of N-terminal pro-brain natriuretic peptide improved the overall classification of recalibrated Framingham, recalibrated Health ABC, and ARIC risk scores by 18%, 12%, and 13%, respectively. In contrast, cystatin C or high-sensitivity C-reactive protein did not add toward incremental risk prediction.
The ARIC HF risk score is more parsimonious yet performs slightly better than the extant risk scores in predicting 10-year risk of incident HF. The inclusion of N-terminal pro-brain natriuretic peptide markedly improves HF risk prediction. A simplified risk score restricted to a patient's age, race, sex, and N-terminal pro-brain natriuretic peptide performs comparably to the full score (area under curve, 0.745) and is suitable for automated reporting from laboratory panels and electronic medical records.
Circulation Heart Failure 05/2012; 5(4):422-9. · 6.29 Impact Factor
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ABSTRACT: Heart failure causes significant morbidity and mortality. Distinguishing risk factors for incident heart failure can help identify at-risk individuals. Orthostatic hypotension may be a risk factor for incident heart failure; however, this association has not been fully explored, especially in nonwhite populations. The Atherosclerosis Risk in Communities Study included 12363 adults free of prevalent heart failure with baseline orthostatic measurements. Orthostatic hypotension was defined as a decrease of systolic blood pressure ≥20 mmHg or diastolic blood pressure ≥10 mmHg with position change from supine to standing. Incident heart failure was identified from hospitalization or death certificate disease codes. Over 17.5 years of follow-up, orthostatic hypotension was associated with incident heart failure with multivariable adjustment (hazard ratio: 1.54 [95% CI: 1.30-1.82]). This association was similar across race and sex groups. A stronger association was identified in younger individuals ≤55 years old (hazard ratio: 1.90 [95% CI: 1.41-2.55]) than in older individuals >55 years old (hazard ratio: 1.37 [95% CI: 1.12-1.69]; interaction P=0.034). The association between orthostatic hypotension and incident heart failure persisted with exclusion of those with diabetes mellitus, coronary heart disease, and those on antihypertensives or psychiatric or Parkinson disease medications. However, exclusion of those with hypertension somewhat attenuated the association (hazard ratio: 1.34 [95% CI: 1.00-1.80]). We identified orthostatic hypotension as a predictor of incident heart failure among middle-aged individuals, particularly those 45 to 55 years of age. This association may be partially mediated through hypertension. Orthostatic measures may enhance risk stratification for future heart failure development.
Hypertension 03/2012; 59(5):913-8. · 6.21 Impact Factor
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03/2012; , ISBN: 978-953-51-0382-0
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ABSTRACT: We examined the relationship between forced expiratory volume in 1 s (FEV(1)), airflow obstruction, and incident heart failure (HF) in black and white, middle-aged men and women in four US communities.
Lung volumes by standardized spirometry and information on covariates were collected on 15 792 Atherosclerosis Risk in Communities (ARIC) cohort participants in 1987-89. Incident HF was ascertained from hospital records and death certificates up to 2005 in 13 660 eligible participants. Over an average follow-up of 14.9 years, 1369 (10%) participants developed new-onset HF. The age- and height-adjusted hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV(1) for both genders, race groups, and smoking status. After multivariable adjustment for traditional cardiovascular risk factors and height, the HRs [95% confidence intervals (CIs)] of HF comparing the lowest with the highest quartile of FEV(1) were 3.91 (2.40-6.35) for white women, 3.03 (2.12-4.33) for white men, 2.11 (1.33-3.34) for black women, and 2.23 (1.37-3.59) for black men. The association weakened but remained statistically significant after additional adjustment for systemic markers of inflammation. The multivariable adjusted incidence of HF was higher in those with FEV(1)/forced vital capacity <70% vs. ≥70%: HR 1.44 (95% CI 1.20-1.74) among men and 1.40 (1.13-1.72) among women. A consistent and positive association with HF was seen for self-reported diagnosis of emphysema and chronic obstructive pulmonary disease, but not for asthma.
In this large population-based cohort with long-term follow-up, low FEV(1) and an obstructive respiratory disease were strongly and independently associated with the risk of incident HF.
European Journal of Heart Failure 02/2012; 14(4):414-22. · 4.90 Impact Factor
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ABSTRACT: The true change in the value of a variable between two time points is often assumed to be a cause or an effect of interest. To our knowledge, this assumption is based on intuition, rather than on any formal theoretical justification.
We used causal directed acyclic graphs to explore the causal properties of a change variable, and critically examined competing structures.
Based on the proposed causal structure, a change variable (true change) is no more than a derived variable. It does not cause anything and is not of causal interest.
A true change is not a variable in the physical world. Therefore, modelling the change between two time points is justified only in a few situations.
Journal of Evaluation in Clinical Practice 02/2012; 18(1):143-8. · 1.23 Impact Factor
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ABSTRACT: Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes.
A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9% and 27.1% were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4% were validated as ADHF, 9.6% as chronic stable HF, and 21.9% as no HF. However, 92.5% of hospitalizations with a primary ICD-9-CM 428 "heart failure" code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95%, positive predictive values from 62-92%, and specificities from 19-96%.
Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.
Circulation Heart Failure 01/2012; 5(2):152-9. · 6.29 Impact Factor
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ABSTRACT: It is tempting to assume that confounding bias is eliminated by choosing controls that are identical to the cases on the matched confounder(s). We used causal diagrams to explain why such matching not only fails to remove confounding bias, but also adds colliding bias, and why both types of bias are removed by conditioning on the matched confounder(s). As in some publications, we trace the logic of matching to a possible tradeoff between effort and variance, not between effort and bias. Lastly, we explain why the analysis of a matched case-control study - regardless of the method of matching - is not conceptually different from that of an unmatched study.
Clinical Epidemiology 01/2012; 4:137-44.
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ABSTRACT: Analogous to rapid ventricular pacing, frequent ventricular premature complexes (VPCs) can predispose over time to cardiomyopathy and subsequent heart failure (HF). We examined the association of frequent VPCs with HF incidence in a population-based cohort, free of HF and coronary heart disease at baseline. At study baseline (1987 to 1989), ≥1 VPC on a 2-minute rhythm electrocardiographic strip was seen in 5.5% (739 of 13,486) of the middle-age (45 to 64 years old at baseline) white and black, men and women of the Atherosclerosis Risk In Communities cohort. Incident HF was defined as the first appearance of International Classification of Diseases code 428.x in the hospital discharge record or death certificate through 2005. During an average follow-up of 15.6 years, incident HF was seen in 10% the participants (19.4% of those with VPCs vs 9.4% of those without). The age-, race-, and gender-adjusted hazard ratio of HF for VPCs was 1.89 (95% confidence interval 1.59 to 2.24). After multivariable adjustment for potential confounders, the hazard ratio of HF for those with any VPC versus no VPC was 1.63 (95% confidence interval 1.36 to 1.96). After additional adjustment for incident coronary heart disease as a time-varying covariate, the hazard ratio was 1.71 (95% confidence interval 1.42 to 2.08). Those with a greater frequency of VPCs or complex VPCs had similar rates of HF compared to those with a single VPC and all had rates greater than those with no VPC. In conclusion, in this large population-based cohort, the presence of VPCs was associated with incident HF, independent of incident coronary heart disease.
The American journal of cardiology 09/2011; 109(1):105-9. · 3.58 Impact Factor
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ABSTRACT: Carotid intima-media thickness and electrocardiographic left ventricular hypertrophy are 2 subclinical cardiovascular disease measures associated with increased risk of total and ischemic strokes. Increased intima-media thickness and electrocardiographic left ventricular hypertrophy also may reflect end-organ hypertensive effects. Information is scant on the associations of these subclinical measures with intracerebral hemorrhage (ICH). We hypothesized that greater carotid intima-media thickness and the presence of electrocardiographic left ventricular hypertrophy would be independently associated with increased ICH incidence.
Among 18,155 participants initially free of stroke in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS), we assessed carotid intima-media thickness, carotid plaque, and electrocardiographic left ventricular hypertrophy. Over a median of 18 years of follow-up, 162 incident ICH events occurred.
After adjustment for other ICH risk factors, carotid intima-media thickness was associated positively with incidence of ICH in both ARIC and CHS. The risk was lowest in study-specific Quartile 1, elevated 1.6- to 2.6-fold in Quartiles 2 to 3, and elevated 2.5 to 3.7-fold in Quartile 4 (P<0.05 for both studies). In CHS, having a carotid plaque was associated with a 2-fold (95% CI, 1.1-3.4) greater ICH risk than having no plaque, but only 1.2-fold (95% CI, 0.76-2.0) greater ICH risk in ARIC. Electrocardiographic left ventricular hypertrophy carried a hazard ratio of ICH of 1.7 (95% CI, 0.77-3.7) in CHS and 2.8 (95% CI, 1.2-6.4) in ARIC.
Our data suggest that people with carotid atherosclerosis and possibly left ventricular hypertrophy are at increased risk not only of ischemic stroke, but also of ICH.
Stroke 09/2011; 42(11):3075-9. · 5.73 Impact Factor
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ABSTRACT: Marginal structural models were developed to account for a so-called time-dependent confounder and to estimate the presumed effect of 'treatment regime' (treatment over time). We present a set of causal axioms, according to which the problem of time-dependent confounding does not exist, and 'treatment regime' affects nothing. Per our axiomatization, marginal structural models do not introduce a new idea of deconfounding, but simply estimate a weighted average of effects. Whenever a weighted average and the weighting scheme can both be rationalized, the models are acceptable. Whenever a weighted average does not estimate an effect (e.g. important effect modification is ignored), or the weights are senseless - the models should not be fit.
Journal of Evaluation in Clinical Practice 08/2011; · 1.23 Impact Factor
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Eyal Shahar
Journal of Evaluation in Clinical Practice 03/2011; 18(3):702-3. · 1.23 Impact Factor
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ABSTRACT: Understanding associations of carotid atherosclerosis with stroke subtypes may contribute to more effective prevention of stroke.
Between 1987 and 1989, 13 560 men and women aged 45 to 64 years and free of clinical stroke took part in the first examination of the Atherosclerosis Risk in Communities (ARIC) study. Incident strokes were ascertained by hospital surveillance.
During an average follow-up of 15.7 years, 82 incident hemorrhagic and 621 incident ischemic strokes (131 lacunar, 358 nonlacunar, and 132 cardioembolic strokes) occurred. The incidence rates of hemorrhagic and ischemic strokes were greater across higher carotid intima-media thickness levels. Although this positive association was observed for all stroke subtypes, the age-, gender-, and race-adjusted risk ratios were higher for cardioembolic and nonlacunar strokes than for hemorrhagic and lacunar strokes. Compared with participants in the lowest quintile (<0.61 mm), the adjusted risk ratios for those in the highest quintile (≥0.85 mm) of intima-media thickness were 2.55 (95% CI, 1.09-5.94) for hemorrhagic, 2.89 (95% CI, 1.50-5.54) for lacunar, 3.61 (95% CI, 2.33-5.99) for nonlacunar, and 6.12 (95% CI, 2.71-13.9) for cardioembolic stroke. The risk ratios were attenuated by additional adjustment for covariates but remained statistically significant for nonlacunar and cardioembolic strokes (P for trend <0.001, respectively). The association between carotid intima-media thickness and lacunar stroke was somewhat stronger in blacks than in whites (P for interaction=0.07).
Carotid atherosclerosis was associated with increased risk of all stroke subtypes, but the association of carotid atherosclerosis with stroke may vary by subtypes.
Stroke 02/2011; 42(2):397-403. · 5.73 Impact Factor
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ABSTRACT: To describe the relationship of lung disease and function with early age-related macular degeneration (AMD) in a population-based study.
A population-based, cross-sectional study of 12,596 middle-aged participants from the Atherosclerosis Risk in Communities Study.
Lung function was assessed by spirometry. Physician diagnosis of asthma and lung disease was ascertained from a standardized questionnaire. AMD signs were graded from fundus photographs according to the Wisconsin grading protocol.
Among the study population, 587 (4.7%) had early AMD, 638 (5.1%) had asthma, and 581 (4.6%) had lung disease. After adjusting for age, gender, smoking, and hypertension, each 1-L increase in predicted forced expiratory volume in 1 second (odds ratio [OR], 1.27; 95% confidence interval [CI], 0.89 to 1.80), forced vital capacity (OR, 1.18; 95% CI, 0.93 to 1.51), and peak expiratory flow rate (OR, 1.12; 95% CI, 0.95 to 1.33) were not significantly associated with early AMD. Forced expiratory volume in 1 second-to-forced vital capacity ratio (second quartile OR, 1.61; 95% CI, 0.88 to 2.93, third quartile OR, 1.65; 95% CI 0.90 to 3.03; fourth quartile OR, 1.28; 95% CI 0.68 to 2.40) was not associated significantly with early AMD. Similarly, asthma (OR, 1.06; 95% CI, 0.86 to 1.27) and other lung diseases (OR, 1.08; 95% CI, 0.90 to 1.29) were not associated with early AMD.
Our data do not support a cross-sectional association between lung disease and risk of early AMD.
American journal of ophthalmology 02/2011; 151(2):375-9. · 3.83 Impact Factor
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ABSTRACT: Background. Recent studies report that acute stroke patients who present to the hospital on weekends have higher rates of 28-day mortality than similar patients who arrive during the week. However, how this association is related to clinical presentation and stroke type has not been systematically investigated. Methods and Results. We examined the association between day of arrival and 28-day mortality in 929 validated stroke events in the ARIC cohort from 1987-2004. Weekend arrival was defined as any arrival time from midnight Friday until midnight Sunday. Mortality was defined as all-cause fatal events from the day of arrival through the 28th day of followup. The presence or absence of thirteen stroke signs and symptoms were obtained through medical record review for each event. Binomial logistic regression was used to estimate odds ratios and 95% confidence intervals (OR; 95% CI) for the association between weekend arrival and 28-day mortality for all stroke events and for stroke subtypes. The overall risk of 28-day mortality was 9.6% for weekday strokes and 10.1% for weekend strokes. In models controlling for patient demographics, clinical risk factors, and event year, weekend arrival was not associated with 28-day mortality (0.87; 0.51, 1.50). When stratified by stroke type, weekend arrival was not associated with increased odds of mortality for ischemic (1.17, 0.62, 2.23) or hemorrhagic (0.37; 0.11, 1.26) stroke patients. Conclusions. Presence or absence of thirteen signs and symptoms was similar for weekday patients and weekend patients when stratified by stroke type. Weekend arrival was not associated with 28-day all-cause mortality or differences in symptom presentation for strokes in this cohort.
Stroke research and treatment. 01/2011; 2011:383012.
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Eyal Shahar
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ABSTRACT: The debate on the metabolic syndrome has attracted great interest among physicians and researchers. This article sheds new light on the term by using a tool called causal diagrams (also known as causal directed acyclic graphs). Formal analysis according to causal and statistical principles reveals little substance behind the new syndrome, as well as numerous false claims. From a research viewpoint, continued use of a variable called 'metabolic syndrome status' should be discouraged.
Journal of Cardiovascular Medicine 10/2010; 11(10):772-9. · 1.51 Impact Factor
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Daniel J Gottlieb,
Gayane Yenokyan,
Anne B Newman,
George T O'Connor,
Naresh M Punjabi,
Stuart F Quan,
Susan Redline,
Helaine E Resnick,
Elisa K Tong,
Marie Diener-West, Eyal Shahar
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ABSTRACT: Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women.
A total of 1927 men and 2495 women > or =40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men < or =70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of any age. Among men 40 to 70 years old, those with AHI > or =30 were 68% more likely to develop coronary heart disease than those with AHI <5. Obstructive sleep apnea predicted incident heart failure in men but not in women (adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI). Men with AHI > or =30 were 58% more likely to develop heart failure than those with AHI <5.
Obstructive sleep apnea is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.
Circulation 07/2010; 122(4):352-60. · 14.74 Impact Factor
