Incidence of heart failure in an urban population
The overall aim of the thesis was to study heart failure (HF) in an urban population, with reference to immigrant status, biological, life style and socioeconomic risk factors. The thesis is based on four papers. Paper I included inhabitants (N=114,917; aged 40-89 years) in the city of Malmö, Sweden, followed from November 1st, 1990 until December 31st, 2007. Paper II-IV used the population-based Malmö Diet and Cancer cohort (n=28,449; aged 45-73 years),followed from 1991-1996 until December 31st, 2008 or June 30th, 2009. Cases of HF were retrieved through the Swedish Hospital Discharge Register. Information on background characteristics in paper I was retrieved from the Population and Housing Census and the Swedish total population register. Participants in paper II-IV underwent sampling of peripheral venous blood, measurement of blood pressure and anthropometric measures and filled out a self-administered questionnaire. The risk of HF hospitalization was significantly higher among immigrants from Finland, Former Yugoslavia and Hungary compared to Swedish natives, after taking marital status, annual income and housing conditions into account. Furthermore, foreign-born had a significantly higher risk for HF hospitalization independently of hypertension, socioeconomic and several life-style risk factors. A significant interaction was seen between waist circumference and immigrant status on incident HF hospitalization; the increased HF risk was limited to immigrants with high waist circumference. Elevated body mass index, waist circumference, waist-hip ratio, body fat percentage and weight increased the risk of HF hospitalization in both sexes, independently of several sociodemographic, life style and biological factors. The joint exposure of high body mass index and high waist-hip ratio, or waist circumference, further increased the risk for HF hospitalization. In addition, the top quartile compared to the bottom quartile of red cell distribution width had a significantly higher risk for HF hospitalization after adjusting for other risk factors. In conclusion, there are substantial differences in risk of hospitalization due to HF among immigrants from different countries. Immigrant status was associated with risk of HF hospitalization independently of hypertension, socioeconomic and several life-style risk factors. Obesity is a risk factor for HF hospitalization, and the joint exposure to high body mass index and high waist-hip ratio or waist circumference further increased the HF risk. Red cell distribution width was found to be associated with long-term incidence of first hospitalization due to HF among middle-aged subjects.
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