Elevated Health Abc Heart Failure Risk Score is Associated with Subclinical Myocardial Stress in Patients Without Heart Failure

The Healthy Aging, Body and Composition (HABC) study established a risk score suggesting modifiable risk factors may contribute to the development of incident heart failure (HF) in elderly populations. We hypothesized that those with higher estimated risk by HABC risk score may have underlying vulnerability for subclinical myocardial stress. We prospectively examined 1025 consecutive non-heart failure subjects with preserved LV ejection fraction (≥50%) who underwent elective coronary angiography during 2002-7, and measured cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) levels (Abbott). From this study cohort (mean age 60.89 ± 10.6 years, 672 (65.5%) with history of coronary artery disease), the median BNP was 71.6pg/mL [interquartile range 30.05-180.05pg/mL], and the median cTnI was 0.002ng/mL [interquartile range 0-0.01ng/mL]). 425 subjects (41.4%) had BNP ≥100pg/mL and 271 (26.4%) had cTnI >0.01ng/mL (both positive is defined as “subclinical myocardial stress”). Based on the Health ABC score for HF risk, 268 (26.1%) had 5-year HF risk of >7%, 330 (32.19%) had 5-year HF risk of 3-7%, 379 (36.9%) had 5-year HF risk of 1-3% and 48 (4.6%) had 5-year HF risk of <1%. Interestingly, subjects with higher calculated risk scores also had higher BNP and cTnI levels (Figure 1&2&3 p<0.01). Heightened risk of developing incident HF based on clinical variables as estimated by HABC score is associated with higher BNP and cTnI levels, which suggests underlying vulnerability for subclinical myocardial stress.