TY - JOUR
T1 - Association of exhaled carbon monoxide with ideal cardiovascular health, circulating biomarkers, and incidence of heart failure in the framingham offspring study
AU - Tun, Bradley
AU - Ehrbar, Rachel
AU - Short, Meghan
AU - Cheng, Susan
AU - Vasan, Ramachandran S.
AU - Xanthakis, Vanessa
N1 - Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/11/3
Y1 - 2020/11/3
N2 - BACKGROUND: Exhaled carbon monoxide (eCO) is directly associated with traditional cardiovascular disease risk factors and incident cardiovascular disease. However, its relation with the cardiovascular health score and incidence of heart failure (HF) has not been investigated. METHODS AND RESULTS: We measured eCO in 3521 Framingham Heart Study Offspring participants attending examination cycle 6 (mean age 59 years, 53% women). We related the cardiovascular health score (composite of blood pressure, fasting plasma glucose, total cholesterol, body mass index, smoking, diet, and physical activity) to eCO adjusting for age, sex, and smoking. Higher cardiovascular health scores were associated with lower eCO (β=−0.02, P<0.0001), even among nonsmok-ers. Additionally, C-reactive protein, plasminogen activator inhibitor-1, fibrinogen, growth differentiation factor-15, homocyst-eine, and asymmetrical dimethylarginine were positively associated with eCO (P≤0.003 for all). The age-and sex-adjusted and multivariable-adjusted heritabilities of eCO were 49.5% and 31.4%, respectively. Over a median follow-up of 18 years, 309 participants (45% women) developed HF. After multivariable adjustment, higher eCO was associated with higher risk of HF (hazards ratio per SD increment: 1.39; 95% CI, 1.19–1.62 [P<0.001]) and with higher risk of HF with reduced ejection fraction (N=144 events; hazard ratio per SD increment in eCO: 1.43; 95% CI, 1.15–1.77 [P=0.001]). CONCLUSIONS: In our community-based sample, higher levels of eCO were associated with lower cardiovascular health scores, an adverse cardiovascular biomarker profile, and a higher risk of HF, specifically HF with reduced ejection fraction. Our find-ings suggest that carbon monoxide may identify a novel pathway to HF development.
AB - BACKGROUND: Exhaled carbon monoxide (eCO) is directly associated with traditional cardiovascular disease risk factors and incident cardiovascular disease. However, its relation with the cardiovascular health score and incidence of heart failure (HF) has not been investigated. METHODS AND RESULTS: We measured eCO in 3521 Framingham Heart Study Offspring participants attending examination cycle 6 (mean age 59 years, 53% women). We related the cardiovascular health score (composite of blood pressure, fasting plasma glucose, total cholesterol, body mass index, smoking, diet, and physical activity) to eCO adjusting for age, sex, and smoking. Higher cardiovascular health scores were associated with lower eCO (β=−0.02, P<0.0001), even among nonsmok-ers. Additionally, C-reactive protein, plasminogen activator inhibitor-1, fibrinogen, growth differentiation factor-15, homocyst-eine, and asymmetrical dimethylarginine were positively associated with eCO (P≤0.003 for all). The age-and sex-adjusted and multivariable-adjusted heritabilities of eCO were 49.5% and 31.4%, respectively. Over a median follow-up of 18 years, 309 participants (45% women) developed HF. After multivariable adjustment, higher eCO was associated with higher risk of HF (hazards ratio per SD increment: 1.39; 95% CI, 1.19–1.62 [P<0.001]) and with higher risk of HF with reduced ejection fraction (N=144 events; hazard ratio per SD increment in eCO: 1.43; 95% CI, 1.15–1.77 [P=0.001]). CONCLUSIONS: In our community-based sample, higher levels of eCO were associated with lower cardiovascular health scores, an adverse cardiovascular biomarker profile, and a higher risk of HF, specifically HF with reduced ejection fraction. Our find-ings suggest that carbon monoxide may identify a novel pathway to HF development.
KW - Carbon monoxide
KW - Cardiac biomarkers
KW - Cardiovascular health
KW - Heart failure
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U2 - 10.1161/JAHA.120.016762
DO - 10.1161/JAHA.120.016762
M3 - Article
C2 - 33100134
AN - SCOPUS:85095671521
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 21
M1 - e016762
ER -