Key result
Coronary artery disease is linked to ~78% higher mortality in adults with congenital heart disease.
Why the study?
With improved survival, adults with congenital heart disease increasingly face acquired cardiovascular risk factors whose impact on late mortality remains incompletely defined.
Cohort (n=9,826)
No
Hazard Ratio: 1.78
p-value: p=0.005
Acquired cardiovascular risk factors and comorbidities significantly increase the risk of late all-cause mortality in adults with congenital heart disease, highlighting the need for comprehensive risk modification alongside CHD-specific care.
Acquired risks may inform ACHD prognosis; extends observational data but leaves intervention effects open for prospective trials.
BACKGROUND AND AIMS: With improved survival, adults with congenital heart disease (ACHD) increasingly face acquired cardiovascular risk factors; however, their impact on late mortality remains incompletely defined. This study aimed to evaluate the contribution of acquired cardiovascular risk factors to mortality in ACHD. METHODS: A total of 9826 ACHD patients (mean age 39.0 ± 16.4 years; 50.3% male) who attended our tertiary centre between 2000 and 2024 were retrospectively analysed. Clinical and demographic data were obtained from a prospectively maintained database. Cox proportional hazards models were used to assess associations between risk factors and all-cause mortality. RESULTS: During a median follow-up of 10.0 years (98 764 patient-years), 1371 patients died (mortality rate 1.39% per patient-year). In multivariable analysis, older age (hazard ratio [HR] 1.07 per year; P < .001), male sex (HR 1.30; P = .026), greater lesion complexity (HR 2.12; P < .001), coronary artery disease (HR 1.78; P = .005), sleep apnoea (HR 2.22; P < .001), depression (HR 1.45; P = .010), and current smoking (HR 1.67; P < .001) were independently associated with higher mortality, while higher income was associated with lower mortality risk. CONCLUSIONS: Both congenital lesion complexity and acquired comorbidities are associated with late mortality in ACHD. These data support the need for comprehensive, multidisciplinary management that incorporates timely modification of general cardiovascular and other risk factors alongside congenital heart disease-specific care.
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Umei et al. (2026) conducted a cohort in Congenital heart disease (n=9,826). Acquired cardiovascular risk factors (e.g., coronary artery disease, sleep apnoea, smoking) vs. Absence of respective risk factors was evaluated on All-cause mortality (HR 1.78 (for coronary artery disease), p=0.005). In adults with congenital heart disease, acquired risk factors like coronary artery disease (HR 1.78), sleep apnoea (HR 2.22), and smoking (HR 1.67) independently increased all-cause mortality risk.
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