Abstract Body: Background: Heart failure (HF) is a leading cause of mortality, particularly among older adults. HF risk scores developed in high-income Western countries are being incorporated into national guidelines in low- and middle-income countries (LMICs) without a systematic evaluation of their performance in these populations. Existing HF risk scores, including those recalibrated for LMICs, fail to accurately capture risk in Brazilian population.
Objective: To evaluate the trajectory of the Multi-Ethnic Study of Atherosclerosis (MESA) heart failure (HF) risk score in a representative Brazilian sample over 10 years and its association with the Life’s Essential 8 health behaviors (LE8HB).
Methods: We analyzed 13,664 Brazilian adults (54.4% women) from six cities, followed from 2008-2010 (W1), 2012-2014 (W2), and 2017-2019 (W3) from the ELSA-Brasil study. The primary outcome was the 10-year MESA HF risk score trajectory, composed of age, sex, smoking status, BMI categories, systolic blood pressure, heart rate, and diabetes status. LE8HB was evaluated based on diet, physical activity, nicotine exposure, and sleep, with scores categorized as high (80-100), moderate (50-79), and low (0-49). Multivariate regression models adjusted for alcohol intake, waist circumference, creatinine, income, and city assessed LE8HB's association with HF risk.
Results: At W1, the mean age was 52.1 years, increasing to 59.6 years at W3. Over this period, the mean heart failure (HF) risk score significantly increased from 4.2 at W1 to 5.0 at W3. Concurrently, the proportion of participants with high adherence to LE8HB increased from 16.0% to 20.3%. We identified three distinct HF risk trajectory groups: low HF risk (W1 mean = 2.1, W2 = 2.3, W3 = 3.0), moderate HF risk (W1 = 4.6, W2 = 4.7, W3 = 5.4), and High HF risk (W1 = 7.7, W2 = 7.8, W3 = 8.6). Participants with higher LE8HB adherence had a significantly lower HF risk score (mean = 5.6, 95% CI: 5.4–5.8) compared to those with low LE8HB adherence (mean = 4.1, 95% CI: 3.9–4.3).
Conclusion: The Multi-Ethnic Study of Atherosclerosis effectively stratified heart failure risk trajectories in Brazilian adults. Although heart failure risk increased across all groups, individuals with healthier behaviors consistently showed lower risk trajectories. The MESA score is a promising tool for recalibration, accounting for lifestyle patterns in the Brazilian population.