Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Pediatr. 2021 Jul 1;175(7):689-697. doi: 10.1001/jamapediatrics.2021.0131.
Preterm birth has been associated with increased risk of heart failure (HF) early in life, but its association with new-onset HF in adulthood appears to be unknown.
To determine whether preterm birth is associated with increased risk of HF from childhood into mid-adulthood in a large population-based cohort.
DESIGN, SETTING, AND PARTICIPANTS: This national cohort study was conducted in Sweden with data from 1973 through 2015. All singleton live births in Sweden during 1973 through 2014 were included.
Gestational age at birth, identified from nationwide birth records.
Heart failure, as identified from inpatient and outpatient diagnoses through 2015. Cox regression was used to determine hazard ratios (HRs) for HF associated with gestational age at birth while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial (genetic and/or environmental) factors.
A total of 4 193 069 individuals were included (maximum age, 43 years; median age, 22.5 years). In 85.0 million person-years of follow-up, 4158 persons (0.1%) were identified as having HF (median [interquartile range] age, 15.4 [28.0] years at diagnosis). Preterm birth (gestational age <37 weeks) was associated with increased risk of HF at ages younger than 1 year (adjusted HR [aHR], 4.49 [95% CI, 3.86-5.22]), 1 to 17 years (aHR, 3.42 [95% CI, 2.75-4.27]), and 18 to 43 years (aHR, 1.42 [95% CI, 1.19-1.71]) compared with full-term birth (gestational age, 39-41 weeks). At ages 18 through 43 years, the HRs further stratified by gestational age were 4.72 (95% CI, 2.11-10.52) for extremely preterm births (22-27 weeks), 1.93 (95% CI, 1.37-2.71) for moderately preterm births (28-33 weeks), 1.24 (95% CI, 1.00-1.54) for late preterm births (34-36 weeks), and 1.09 (95% CI, 0.97-1.24) for early term births (37-38 weeks). The corresponding HF incidence rates (per 100 000 person-years) at ages 18 through 43 years were 31.7, 13.8, 8.7, and 7.3, respectively, compared with 6.6 for full-term births. These associations persisted when excluding persons with structural congenital cardiac anomalies. The associations at ages 18 through 43 years (but not <18 years) appeared to be largely explained by shared determinants of preterm birth and HF within families. Preterm birth accounted for a similar number of HF cases among male and female individuals.
In this large national cohort, preterm birth was associated with increased risk of new-onset HF into adulthood. Survivors of preterm birth may need long-term clinical follow-up into adulthood for risk reduction and monitoring for HF.
早产与生命早期心力衰竭（HF）的风险增加有关，但早产与成年后新发 HF 的关系似乎尚不清楚。
在一个大型基于人群的队列中，确定早产是否与儿童期至中年期 HF 的风险增加有关。
设计、地点和参与者：本全国性队列研究在瑞典进行，数据来自 1973 年至 2015 年。包括 1973 年至 2014 年瑞典所有的单胎活产儿。
从全国性的出生记录中确定出生时的胎龄。
心力衰竭，通过 2015 年的住院和门诊诊断确定。使用 Cox 回归确定与出生时胎龄相关的 HF 的危险比（HR），同时调整其他围产期和产妇因素。同胞分析评估潜在的未测量的共同家族（遗传和/或环境）因素的混杂作用。
共纳入 4193069 人（最大年龄 43 岁；中位年龄 22.5 岁）。在 8500 万个人年的随访中，4158 人（0.1%）被诊断为 HF（中位[四分位间距]年龄，诊断时为 15.4[28.0]岁）。早产（胎龄<37 周）与 1 岁以下（调整后 HR[aHR]，3.86-5.22）、1 至 17 岁（aHR，2.75-4.27）和 18 至 43 岁（aHR，1.19-1.71）时 HF 的风险增加有关，与足月出生（胎龄 39-41 周）相比。在 18 至 43 岁时，进一步按胎龄分层的 HR 为：极早产（22-27 周）4.72（95%CI，2.11-10.52）；中度早产（28-33 周）1.93（95%CI，1.37-2.71）；晚期早产（34-36 周）1.24（95%CI，1.00-1.54）；早期早产（37-38 周）1.09（95%CI，0.97-1.24）。在 18 至 43 岁时，相应的 HF 发病率（每 10 万人年）分别为 31.7、13.8、8.7 和 7.3，而足月出生的发病率为 6.6。当排除结构性先天性心脏异常患者后，这些关联仍然存在。在 18 岁至 43 岁时的关联（但 18 岁以下时没有）似乎主要是由家庭内早产和 HF 的共同决定因素造成的。在男性和女性个体中，早产导致的 HF 病例数量相似。
在这个大型的全国性队列中，早产与成年后新发 HF 的风险增加有关。早产幸存者可能需要终生的临床随访，以降低风险并监测 HF。
