FIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C.
Adult
Anti-HIV Agents
/ adverse effects
Female
HIV Infections
/ diagnosis
HIV Long-Term Survivors
Health Status
Heart Failure
/ diagnosis
Hepatitis C
/ diagnosis
Humans
Incidence
Liver Cirrhosis
/ diagnosis
Male
Middle Aged
Prognosis
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke Volume
Time Factors
United States
/ epidemiology
Ventricular Function, Left
Veterans Health
Viral Load
Cohort
Ejection fraction
HIV
Heart failure
Hepatitis
Liver fibrosis
Journal
Progress in cardiovascular diseases
ISSN: 1873-1740
Titre abrégé: Prog Cardiovasc Dis
Pays: United States
ID NLM: 0376442
Informations de publication
Date de publication:
Historique:
received:
12
02
2020
accepted:
12
02
2020
pubmed:
19
2
2020
medline:
23
6
2020
entrez:
19
2
2020
Statut:
ppublish
Résumé
Liver fibrosis, is independently associated with incident heart failure (HF). Investigating the association between liver fibrosis and type of HF, specifically HF with reduced ejection fraction (EF; HFrEF) or HF with preserved ejection fraction (HFpEF), may provide mechanistic insight into this association. We sought to determine the association between liver fibrosis score (FIB-4) and type of HF, and to assess whether HIV or hepatitis C status modified this association. We included patients alive on or after 4/1/2003 from the Veterans Aging Cohort Study. We followed patients without prevalent cardiovascular disease until their first HF event, death, last clinic visit, or 9/30/2015. We defined liver fibrosis as: likely advanced fibrosis (FIB-4 > 3.25), indeterminate (FIB-4 range 1.45-3.25), unlikely advanced fibrosis (FIB-4 < 1.45). Primary outcomes were HFrEF and HFpEF (defined using ICD-9 diagnoses for HF, and EF extracted from electronic medical records using natural language processing). Cox proportional hazards models were adjusted for potential confounders and used to estimate hazard ratios (HR). Among 108,708 predominantly male (96%) participants mean age was 49 years. Likely advanced fibrosis was present in 4% at baseline and was associated with an increased risk of HFpEF [HR (95% confidence interval)] [1.70 (1.3-2.3)]; and non-significantly with HFrEF [1.20 (0.9-1.7)]. These associations were not modified by HIV or hepatitis C status. Likely advanced fibrosis was independently associated with incident HFpEF but not HFrEF. This suggests that risk factors and/or mechanisms for liver fibrosis may have greater overlap with those for HFpEF than HFrEF.
Sections du résumé
BACKGROUND
Liver fibrosis, is independently associated with incident heart failure (HF). Investigating the association between liver fibrosis and type of HF, specifically HF with reduced ejection fraction (EF; HFrEF) or HF with preserved ejection fraction (HFpEF), may provide mechanistic insight into this association. We sought to determine the association between liver fibrosis score (FIB-4) and type of HF, and to assess whether HIV or hepatitis C status modified this association.
METHODS
We included patients alive on or after 4/1/2003 from the Veterans Aging Cohort Study. We followed patients without prevalent cardiovascular disease until their first HF event, death, last clinic visit, or 9/30/2015. We defined liver fibrosis as: likely advanced fibrosis (FIB-4 > 3.25), indeterminate (FIB-4 range 1.45-3.25), unlikely advanced fibrosis (FIB-4 < 1.45). Primary outcomes were HFrEF and HFpEF (defined using ICD-9 diagnoses for HF, and EF extracted from electronic medical records using natural language processing). Cox proportional hazards models were adjusted for potential confounders and used to estimate hazard ratios (HR).
RESULTS
Among 108,708 predominantly male (96%) participants mean age was 49 years. Likely advanced fibrosis was present in 4% at baseline and was associated with an increased risk of HFpEF [HR (95% confidence interval)] [1.70 (1.3-2.3)]; and non-significantly with HFrEF [1.20 (0.9-1.7)]. These associations were not modified by HIV or hepatitis C status.
CONCLUSION
Likely advanced fibrosis was independently associated with incident HFpEF but not HFrEF. This suggests that risk factors and/or mechanisms for liver fibrosis may have greater overlap with those for HFpEF than HFrEF.
Identifiants
pubmed: 32068085
pii: S0033-0620(20)30050-5
doi: 10.1016/j.pcad.2020.02.010
pmc: PMC7278895
mid: NIHMS1587068
pii:
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
184-191Subventions
Organisme : NIAID NIH HHS
ID : P30 AI050409
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01 HL134147
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL146588
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK113252
Pays : United States
Informations de copyright
Copyright © 2020. Published by Elsevier Inc.
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