Epidemiology of Heart Failure - Project description
Background
Heart failure, including systolic and diastolic dysfunction, has rarely been investigated in epidemiological studies up to now, because expensive echocardiographic tests are required to differentiate the types of cardiac dysfunction. Thus, little was known until now about the prevalence and course of heart failure and the currently predominant determinants of its incidence in the German population.
Objective
The objective of the epidemiology subproject is to collect up-to-date reliable data on the prevalence and incidence of the various forms of heart failure in Germany. The determinants of the development of heart failure in the population are also being investigated. Determinants include gender, body fat distribution, dietary and lifestyle factors, arterial hypertension and left ventricular hypertrophy, as well as their changes over time (increase and decrease).
Implementation
Subproject 4 is based on the close collaboration of three large population-based prospective studies in Germany: the KORA study in the Augsburg region, the SHIP study in Western Pomerania and the EPIC-Potsdam study. Projects relating specifically to heart failure were incorporated in these ongoing studies. In the KORA ECHO-LVH substudy, over 1,000 people between the ages of 25 and 74 years were again examined with regard to the occurrence of diastolic and systolic dysfunction. In the SHIP study, the 5-year follow-up examination of approximately 3,500 participants between the ages of 20 and 79 years was likewise carried out using echocardiographic methods. Finally, the EPIC-Potsdam study includes an 8-year follow-up for more than 27,000 people, for whom incident fatal and non-fatal cases of symptomatic cardiac insufficiency were recorded.
The analyses of these extensive data bases are currently in progress. The 10-year follow-up of the KORA study focuses on the echocardiographically measured changes in cardiac function. Interesting correlations to prehypertension, changes in weight and prevalent and incident diabetes mellitus were found. The first population-based data on the 5-year incidence of cardiac dysfunction and heart failure in eastern Germany, which generally has a higher rate of cardiovascular disease, will soon be available from the SHIP study, in which the echocardiographic procedures were less complex (no tissue Doppler imaging). Special analyses for the EPIC-Potsdam study, which investigated the influence of exercise, diet and biomarkers on the development of heart failure as part of embedded case control studies, show that diet also appears to play a role in the development of heart failure which has received little attention up to now.
Added value via networking
The enhancement of the collaboration and network formation succeeded thanks to the integration of state-of-the-art echocardiographic examination techniques as well as modern biometric analyses. The coordination of the analytical process among the three cohort studies was accomplished by means of coordination meetings, project conferences and workshops. The combination of scientific expertise in cardiology and epidemiology in this form is unique in Germany and facilitates new insights into the progression and the determinants of cardiac dysfunction. This work is reinforced by collaboration with subprojects 7 and 15.