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Original Articles

Predictors of Heart Failure in Patients With Stable Coronary Artery Disease

A PEACE Study

Eldrin F. Lewis, MD, MPH; Scott D. Solomon, MD; Kathleen A. Jablonski, PhD; Madeline Murguia Rice, PhD; Francesco Clemenza, MD; Judith Hsia, MD; Aldo P. Maggioni, MD; Miguel Zabalgoitia, MD; Thao Huynh, MD; Thomas E. Cuddy, MD; Bernard J. Gersh, MB, ChB, DPhil; Jean Rouleau, MD; Eugene Braunwald, MD; Marc A. Pfeffer, MD, PhD, FRCP on behalf of the PEACE Investigators

From the Cardiovascular Division (E.F.L., S.D.S., E.B., M.A.P.), Brigham and Women’s Hospital, Boston, Mass; Biostatistics Center (K.A.J., M.M.R.), George Washington University, Washington, DC and Rockville, Md; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (F.C.), Palermo, Italy; Astra Zeneca (J.H.), Wilmington, Del; AMNCO Foundation (A.P.M.), Florence, Italy; Department of Medicine (M.Z.), University of Texas Health Science Center, San Antonio, Tex; Montreal General Hospital (T.H.), McGill University Health Center, Montreal, Quebec, Canada; University of Manitoba (T.E.C.), Winnipeg, Manitoba, Canada; Division of Cardiovascular Disease and Internal Medicine (B.J.G.), Mayo Clinic, Rochester, Minn; and the Research Center, Université de Montreal (J.R.), Montreal, Canada.

Correspondence to Eldrin F. Lewis, MD, MPH, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail eflewis{at}partners.org

Received September 22, 2008; accepted February 18, 2009.

Background— Heart failure (HF) is a disease commonly associated with coronary artery disease. Most risk models for HF development have focused on patients with acute myocardial infarction. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition population enabled the development of a risk model to predict HF in patients with stable coronary artery disease and preserved ejection fraction.

Methods and Results— In the 8290, Prevention of Events with Angiotensin-Converting Enzyme Inhibition patients without preexisting HF, new-onset HF hospitalizations, and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if P<0.05. A risk score was developed and converted to an integer-based scoring system. Among the Prevention of Events with Angiotensin-Converting Enzyme Inhibition population (age, 64±8; female, 18%; prior myocardial infarction, 55%), there were 268 cases of fatal and nonfatal HF. Twelve characteristics were associated with increased risk of HF along with several baseline medications, including older age, history of hypertension, and diabetes. Randomization to trandolapril independently reduced the risk of HF. There was no interaction between trandolapril treatment and other risk factors for HF. The risk score (range, 0 to 21) demonstrated excellent discriminatory power (c-statistic 0.80). Risk of HF ranged from 1.75% in patients with a risk score of 0% to 33% in patients with risk score 16.

Conclusion— Among patients with stable coronary artery disease and preserved ejection fraction, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved ejection fraction.

Key Words: heart failure • aging • epidemiology • obesity • chronic ischemic heart disease • risk factors

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