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BACKGROUND: Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations. METHODS: We conducted a community based HF registration study over a 10 year period in an aging cohort of the Japanese general population. RESULTS: A total of 2598 cases of hospitalized HF were registered during the survey period. Of these 1413 cases (55%) were initial admissions for HF (incident case). The study period was divided into five 2-year terms (T1, 2003-2004; T2, 2005-2006; T3, 2007-2008; T4, 2009-2010; T5, 2011-2012), and data were compared among the terms. Age adjusted incidence of HF (per 105 person-year) remained stable in men, but decreased significantly by 25% in women (from 104 at T1 to 79 at T5; p for trend < 0.05). Among incident cases who underwent echocardiography (≈ 90%), the proportion of HF with preserved EF increased in men (from 32% at T1 to 43% at T5; p for trend < 0.05), and was relatively high and remained stable throughout the study period in women (from 52% at T1 to 58% at T5; p for trend; NS). CONCLUSION: Although the incidence of HF has declined especially in women between 2003 and 2012 in the study population, the proportion of HF with preserved EF has increased over time. These trends suggest a future prevalence of HF with preserved EF rather than HF with reduced EF in aging Asian populations.

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Few reports have examined the utility of plasma B-type natriuretic peptide (BNP) testing for cardiovascular (CV) risk stratification in real-world hypertensive subjects. Subjects of the study were community-based hypertensive patients (n = 5,865). The CV event rate within each BNP quartile was estimated, and a Cox regression model was used to determine the relative hazard ratio (HR) among the quartiles. Furthermore, to determine the usefulness of BNP as a biomarker in combination with the Framingham risk score (FRS), the predictive abilities in terms of area under the curve of receiver operating characteristic analysis, net reclassification improvement, and integrated discrimination improvement indices were determined. The mean follow-up duration was 5.6 years. The highest quartile showed a significantly higher rate of CV events compared with the lower quartiles (p <0.001). After adjustment for established CV risk factors, the HR for CV events increased significantly according to the quartile (p value for trend <0.03), and the HR for the highest quartile was significantly elevated compared with the lowest quartile (HR 1.59, 95% confidence interval 1.16 to 2.19). The predictive abilities of BNP in terms of sensitivity and specificity for CV events were comparable with those of FRS. When BNP was added to an FRS-only model, the predictive abilities in terms of area under receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement were significantly increased (all; p <0.001). Elevated BNP levels are thus a useful biomarker for CV risk stratification in unselected real-world hypertensive subjects. Adding BNP to an established CV risk score improves the predictive ability in this cohort.

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Several recent studies have suggested that arterial stiffness parameters such as peripheral pulse pressure (PPP), central blood pressure (CBP), and pulse wave velocity (PWV) are more accurate markers than brachial blood pressure for prediction of cardiovascular (CV) events. However, it remains unknown which arterial stiffness parameter is the most useful for predicting CV risk in the general population. Participants in the present study were randomly selected from the 40 to 79 year age group in the general population (n = 973; mean age, 59). PPP was determined in the upper arm with an oscillometric device. CBP was estimated noninvasively by radial pulsatile analysis, and brachial-ankle PWV was measured using a validated automatic device. A follow-up survey assessing the incidence of CV events including CV death was carried out after the baseline study. The mean follow-up duration was 7.8 years. Subjects were divided into quartiles according to PPP, CBP, or PWV. Event-free rates among the PWV quartiles were clearly divergent (P < 0.001); however, the rates among quartiles for the other parameters were not significant. In a multivariate Cox regression model, both the 90th percentile level of PWV (HR = 2.51, 95% CI; 1.21 - 5.22: P = 0.014) and the increase in PWV per one standard deviation (HR = 1.42, 95% CI; 1.06 - 1.90: P = 0.019) were significantly associated with risk of CV events. The area under the curves of the receiver operating characteristics analysis for CV event prediction of PWV was significantly larger than the others (P = 0.002 versus PPP; P = 0.043 versus systolic CBP). The measurement of brachial-ankle PWV is more useful than determination of PPP or CBP for identifying subjects at high risk of CV events within the general population.

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BACKGROUND: Several types of structural heart disease are important precursors for congestive heart failure or cardioembolic stroke. We have previously demonstrated that plasma B-type natriuretic peptide (BNP) measurement is useful for detection of structural heart disease in a multiphasic health screening setting. To extend our hypothesis to the general population, the utility of BNP testing for identifying structural heart disease was assessed in a general population and in subgroups divided by sex, age, and presence/absence of risk factors. METHODS AND RESULTS: This cross-sectional cohort study measured plasma BNP concentrations in 993 randomly selected community-dwelling adults (mean age 58 years). All subjects underwent plasma BNP measurement and transthoracic echocardiography. Using prejudged criteria, 41 subjects were diagnosed to have some form of structural heart disease (mild left ventricular systolic dysfunction in 11, valvular heart disease in 9, hypertensive heart disease in 3, hypertrophic cardiomyopathy in 2, ischemic heart disease in 2, lone atrial fibrillation in 14). The utility of BNP testing was evaluated by receiver operating characteristic (ROC) analysis and by cost analysis for detection of 1 case within each subgroup of the cohort. Overall, the sensitivity and specificity of BNP testing for identification of structural heart disease were 61% and 92%, respectively. The area under the ROC curve was 0.77 (95% CI; 0.74-0.79). When sex-specific ROC analyses were performed, sensitivity and specificity were 61% and 91% in men, and 50% and 95% in women, respectively. Although the performance of BNP testing on the basis of these figures might be suboptimal, efficacy was improved in subgroups with a high prevalence of heart disease (>8%) such as the cohort aged > or =65 years (men, area under ROC curve = 0.88; cost

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Arterial stiffness as determined by aortic pulse wave velocity (PWV) has been shown to predict cardiovascular events in high-risk subjects such as those with hypertension or end-stage renal disease. Although it is suspected that low-grade inflammation as represented by increased C-reactive protein (CRP) plays an important role in the progression of atherosclerosis, it is not yet known whether serum CRP levels are associated with PWV. To examine the relationship between brachial-ankle PWV (baPWV) and serum CRP levels, several cardiovascular risk factors including these two markers (baPWV and CRP) were measured in 870 participants (mean age 59 years) randomly selected from a general population. Age, male gender, systolic blood pressure, heart rate, diabetes, and serum CRP levels increased with the quartiles divided by baPWV (all, p<0.01). By multiple regression analysis, age (p<0.001), systolic blood pressure (p<0.001), heart rate (p<0.001), body mass index (p<0.001), and CRP (p<0.01) were significant and independent predictors for baPWV. In conclusion, this cross sectional study has demonstrated in the general population that the arterial stiffness marker baPWV was independently correlated with serum CRP levels after adjustment for other established cardiovascular risks factors. This result suggests that baPWV may be a surrogate marker for atherosclerotic vascular damages including an inflammatory component.

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