Open Access Research article

A comparison of risk factors for mortality from heart failure in Asian and non-Asian populations: An overview of individual participant data from 32 prospective cohorts from the Asia-Pacific Region

Rachel R Huxley1*, Federica Barzi2, Jean Woo3, Graham Giles4, Tai Hing Lam5, Kazem Rahimi67, Suma Konety8, Takayoshi Ohkubo9, Sun Ha Jee10, Xianghua Fang11, Mark Woodward122 and Asia Pacific Cohort Studies Collaboration

Author Affiliations

1 Epidemiology & Biostatistics Division, School of Population Health, University of Queensland, Brisbane, Australia

2 The George Institute for Global Health, University of Sydney, Sydney, Australia

3 Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

4 Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia

5 School of Public Health/Department of Community Medicine, The University of Hong Kong, Hong Kong, China

6 George Centre for Healthcare Innovation, University of Oxford, Oxford, UK

7 Department of Cardiovascular Medicine, University of Oxford, Oxford, UK

8 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA

9 Department of Health Science, Shiga University of Medical Science, Shiga, Japan

10 Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea

11 Department of Epidemiology and Social Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China

12 Division of Epidemiology, Johns Hopkins University, Baltimore, USA

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BMC Cardiovascular Disorders 2014, 14:61  doi:10.1186/1471-2261-14-61

Published: 3 May 2014



Most of what is known regarding the epidemiology of mortality from heart failure (HF) comes from studies within Western populations with few data available from the Asia-Pacific region where the burden of heart failure is increasing.


Individual level data from 543694 (85% Asian; 36% female) participants from 32 cohorts in the Asia Pacific Cohort Studies Collaboration were included in the analysis. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality from HF were estimated separately for Asians and non-Asians for a quintet of cardiovascular risk factors: systolic blood pressure, diabetes, body mass index, cigarette smoking and total cholesterol. All analyses were stratified by sex and study.


During 3,793,229 person years of follow-up there were 614 HF deaths (80% Asian). The positive associations between elevated blood pressure, obesity, and cigarette smoking were consistent for Asians and non-Asians. There was evidence to indicate that diabetes was a weaker risk factor for death from HF for Asians compared with non-Asians: HR 1.26 (95% CI: 0.74-2.13) versus 3.04 (95% CI 1.76-5.25) respectively; p for interaction = 0.022. Additional adjustment for covariates did not materially change the overall associations. There was no good evidence to indicate that total cholesterol was a risk factor for HF mortality in either population.


Most traditional cardiovascular risk factors including elevated blood pressure, obesity and cigarette smoking appear to operate similarly to increase the risk of death from HF in Asians and non-Asians populations alike.

Meta-analysis; Heart failure; Epidemiology