Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Eur J Heart Fail. 2018 Jun;20(6):989-997. doi: 10.1002/ejhf.1163. Epub 2018 Feb 19.
Heart failure (HF) incidence appears to increase among younger individuals, raising questions of how risk factors affect the younger population. We investigated the association of cognitive performance in late adolescence with long-term risk of early HF.
We followed a cohort of Swedish men enrolled in mandatory military conscription in 1968-2005 (n = 1 225 300; mean age 18.3 years) until 2014 for HF hospitalization, using data from the Swedish National Inpatient Registry. Cognitive performance (IQ) was measured through a combination of tests, separately evaluating logical, verbal, visuospatial, and technical abilities. The results were standardized, weighted, and presented as stanines of IQ. The association between IQ and risk of HF was estimated using Cox proportional hazards models. In follow-up, there were 7633 cases of a first HF hospitalization (mean age at diagnosis 50.1 years). We found an inverse relationship between global IQ and risk of HF hospitalization. Using the highest IQ stanine as reference, the adjusted hazard ratio for the lowest IQ with risk of HF was 3.11 (95% confidence interval 2.60-3.71), corresponding to a hazard ratio of 1.32 (95% CI 1.28-1.35) per standard deviation decrease of IQ. This association proved persistent across predefined categories of HF with respect to pre-existing or concomitant co-morbidities; it was less apparent among obese conscripts (P for interaction =0.0004).
In this study of young men, IQ was strongly associated with increased risk of early HF. The medical profession needs to be aware of this finding so as to not defer diagnosis.
心力衰竭（HF）的发病率似乎在年轻人中增加，这引发了一个问题，即危险因素如何影响年轻人群。我们研究了青少年晚期的认知表现与早期 HF 的长期风险之间的关联。
我们对 1968 年至 2005 年期间参加瑞典强制性兵役征召的队列中的瑞典男性进行了随访（n=1225300；平均年龄 18.3 岁），直至 2014 年发生 HF 住院治疗，使用瑞典国家住院患者登记处的数据。认知表现（智商）通过测试组合进行测量，分别评估逻辑、语言、视觉空间和技术能力。结果进行了标准化、加权，并以智商的 stanine 表示。使用 Cox 比例风险模型估计智商与 HF 风险之间的关联。在随访期间，有 7633 例首次 HF 住院（诊断时的平均年龄为 50.1 岁）。我们发现整体智商与 HF 住院风险之间存在负相关关系。以最高智商 stanine 为参考，智商最低的 HF 风险调整后的危险比为 3.11（95%置信区间 2.60-3.71），相当于 IQ 每降低一个标准差，HF 的危险比为 1.32（95%CI 1.28-1.35）。这种关联在 HF 预先存在或并发合并症的预先定义类别中仍然存在；在肥胖应征者中则不太明显（P 交互=0.0004）。
在这项对年轻男性的研究中，智商与早期 HF 的风险增加密切相关。医学界需要意识到这一发现，以免延误诊断。
