Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P‐TIMI 50 trial

Abstract

Background Heart failure (HF) is a growing public health problem and ischemic heart disease is an important risk factor. Understanding the epidemiology of HF in patients with atherosclerosis may help identify subgroups at greater risk who have the potential to derive greater benefit from preventive strategies. Methods and Results The TRA 2°P‐TIMI 50 trial randomized 26,449 patients with stable atherosclerosis to the antiplatelet agent vorapaxar versus placebo. Hospitalization for HF (HHF) endpoints were adjudicated from serious adverse events by blinded structured review using established definitions. HHF incidence was estimated using Kaplan–Meier analysis. Independent predictors of HHF risk were identified using multivariable logistic regression. The effect of vorapaxar on HHF risk was explored using Cox regression. The estimated incidence of HHF at 3 years was 1.6%. Independent predictors of HHF included prior HF (adjusted odds ratio [adj‐OR]: 8.31; 95% confidence interval [CI]: 6.56–10.54), age (adj‐OR [per 10 years]: 1.67; 95% CI: 1.47–1.89), type 2 diabetes mellitus (T2DM; adj‐OR: 2.55; 95% CI: 2.01–3.24), polyvascular disease (two‐territory disease, adj‐OR: 1.89; 95% CI: 1.46–2.44; three‐territory disease, adj‐OR: 2.68; 95% CI: 1.94–3.70), chronic kidney disease (CKD; adj‐OR: 1.65; 95% CI: 1.30–2.11), body mass index (BMI; adj‐OR [per 5 kg/m2]: 1.15; 95% CI: 1.03–1.27), prior myocardial infarction (MI) (adj‐OR: 1.35; 95% CI: 1.03–1.78), and hypertension (adj‐OR: 1.44; 95% CI: 1.02–2.04). Patients who experienced HHF during follow‐up had higher rates of subsequent rehospitalization and death. Vorapaxar did not modify the risk of HHF. Conclusions In patients with stable atherosclerosis, prior HF, age, T2DM, polyvascular disease, CKD, BMI, prior MI, and hypertension are important predictors of HHF risk.

Assessment of Atherothrombotic Risk in Patients With Type 2 Diabetes Mellitus

“…For example, lipid-lowering therapies and antiplatelet agents are highly effective for reducing atherothrombotic risk but are not effective for reducing HF risk. 6,25 As such, guidelines have recommended that clinicians consider comorbidities and anticipated treatment benefits when making therapeutic decisions for patients with T2DM. Risk categories are defined by predicted 3-year risk of myocardial infarction or ischemic stroke.…”

Avaliação Do Risco Cardiovascular E Intervenções Terapêuticas Na Doença Arterial Periférica

“…Uma meta-análise de 15 estudos randomizados com inibidores de SGLT2 e mais de 63 mil pacientes não confirmou nenhuma diferença significativa nos eventos de amputação 82 . Recentemente foi identificado que DM, doença polivascular e doença renal crônica são preditores independentes de hospitalização por IC em uma população com doença aterosclerótica estável 83 .…”

Letter to the editor: Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: The contribution of previous heart failure to heart failure hospitalization may be overestimated

“…We have read with great interest the article by Freedman et al, 1 highlighting that the risk of heart failure hospitalization (HHF) is higher in stable atherosclerosis patients with previous heart failure, type 2 diabetes mellitus, and polyvascular disease. After careful reading, we would like to present some opinions from different perspectives.…”