Key result
Coronary heart disease and stroke linked to increased 10-year new-onset HF incidence of up to ~25%.
Why the study?
The risk of heart failure in stroke patients remains poorly characterized despite the potential contributions of stroke-heart syndrome.
What is the incidence and risk of new-onset heart failure in patients with coronary heart disease and stroke compared to matched controls?
Cohort (n=79,548)
What is the incidence and risk of new-onset heart failure in patients with coronary heart disease and stroke compared to matched controls?
Absolute Event Rate: 25.3% vs 6.9%
Patients with coronary heart disease and stroke have a significantly higher 10-year risk of developing heart failure compared to controls, with hypertension and obesity being notable risk factors, particularly in stroke patients.
HF incidence is highest after CHD and lowest after hemorrhagic stroke; extends stroke-heart syndrome characterization but leaves causal and management implications open.
Heart failure (HF) is a major global health issue, with coronary heart disease (CHD) and stroke being risk factors with different mechanisms. The risk of HF in stroke patients remain poorly characterized despite the potential contributions of "stroke-heart syndrome." This study aimed to evaluate HF incidence and risk factors across different cardiovascular disease (CVD) subtypes in a large population-based Chinese cohort. This study included 13,258 CVD patients, i.e. 3,470 patients with CHD (including 610 with myocardial infarction [MI]) and 10,048 with total stroke (comprising 8,631 ischemic and 1,515 hemorrhagic stroke), and 66,290 age- and sex-matched controls without CVD (1:5 ratio). The primary outcome was new-onset HF. Cumulative incidence functions were estimated with non-HF death as a competing event, stratified by CVD subtypes. Cox proportional hazard models were used to assess the risk factors of HF and compare relative hazard ratio (HR) between CHD and stroke patients. The 10-year cumulative incidence of HF was 25.3% in patients with CHD (24.6% in MI patients), 13.5% in stroke patients (14.7% and 7.3% for ischemic and hemorrhagic stroke, respectively), and 6.9% in controls. Hypertension (81.8% in CHD, 81.0% in stroke) significantly increased HF risk compared to those without it (incidence rate ratio: 1.74, 95% CI: 1.41 to 2.12 for stroke; 1.42, 95% CI: 1.12 to 1.78 for CHD). Obesity showed a stronger association with HF in stroke patients than in CHD patients (HR: 1.43, 95%CI: 1.15 to 1.78 vs 0.94, 95%CI: 0.69 to 1.28, ratio of HRs: 1.67, 95% CI: 1.14 to 2.42). Other significant risk factors in both CHD and stroke patients include older age, male sex, former smoking, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. In conclusion, heart failure incidence varies by CVD subtypes, with the highest risk rates in CHD and MI patients, followed by stroke. Hypertension and obesity notably increase HF risk for stroke patients. Tailored risk management strategies are needed, considering the differential impact of risk factors across CVD subtypes.
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Liu et al. (2025) conducted a cohort in Coronary Heart Disease and Stroke (n=79,548). Coronary heart disease and stroke vs. Matched controls without cardiovascular disease was evaluated on new-onset HF. Coronary heart disease and stroke were associated with a 10-year cumulative incidence of new-onset heart failure of 25.3% and 13.5%, respectively, compared to 6.9% in matched controls.
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