Coller JM, Gong FF, McGrady M, et al. - For asymptomatic structural, systolic, and diastolic abnormalities that predict symptomatic heart failure (HF), different risk factors were unveiled. Such risk factors together with the interactions between them reveal how these structural, systolic, and diastolic abnormalities represent unique trajectories that result in symptomatic HF. Enhanced knowledge of these trajectories could help design HF prophylaxis strategies.

• A cohort of 3,190 participants at increased risk of cardiovascular disease (with age ≥ 60 years and one or more of hypertension, diabetes, ischemic heart disease, valvular heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment) was analyzed.

• For isolated structural abnormality, risk factors included elevated body mass index (BMI), non-steroidal anti-inflammatory drug therapy, and alcohol consumption, whereas a lower risk was evident in relation to male gender, raised heart rate, atrial fibrillation (AF), angiotensin-converting enzyme inhibitor therapy, and obstructive sleep apnea.

• For isolated systolic abnormality, risk factors were male gender, smoking, increased systolic blood pressure, and physical inactivity, whereas a lower risk was seen with increased pulse pressure and with antihypertensive therapy.

• For isolated diastolic abnormality, risk factors comprised increased age, blood pressure, amino-terminal pro-B-type natriuretic peptide level, and warfarin therapy (associated with AF) whereas elevated heart rate and triglyceride level (associated with BMI) were related to a lower risk.

• Interactions between risk factors varied for structural, systolic, and diastolic abnormalities.