부산대학교 도서관

Introduction:Exhaled carbon monoxide (eCO) is associated with traditional cardiovascular disease (CVD) risk factors, the development of metabolic syndrome, subclinical CVD and incident CVD. However, the association of eCO with the AHA defined cardiovascular health score (CVH), newer cardiovascular (CV) biomarkers and the incidence of heart failure (HF) is unexplored.Hypothesis:We hypothesized that the CVH score is inversely associated with eCO whereas biomarkers of CVD risk will be positively associated. Additionally, we hypothesized that higher eCO is associated with an increased risk of HF, including subtypes with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF).Methods and Results:The study sample (n= 3,454) consists of 53% women, with mean age of 59 years for both men and women. We related the CVH score to eCO (a surrogate of blood CO concentration). After adjustment for age and sex, an ideal CVH score (defined as nonsmoker, ideal body mass index, regular physical activity, healthy diet, optimal serum total cholesterol concentrations, optimal blood pressure and absence of diabetes) was associated with a lower eCO (?=-0.07, P<0.0001). Additionally, eCO was positively associated with the following biomarkers: C-reactive protein, plasminogen activator inhibitor-1, fibrinogen, growth differentiation factor-15, homocysteine and asymmetrical dimethylarginine (P?0.003 for all). Over a follow-up period of 20 years, 309 participants developed HF among 3416 individuals at risk. After multivariable adjustment, eCO was associated with incident heart failure (hazards ratio (HR) per SD increment: 1.39, 95% CI: 1.19-1.62; P<0.0001) and with incident HFrEF (N=144 events; HR per SD increment: 1.43, 95% CI: 1.15-1.77; P=0.001). There was not a significant association between CO and incident HFpEF (N=108 events; HR per SD increment: 1.30, 95% CI: 0.98-1.74; P=0.07).Conclusion:Overall, our findings suggest that eCO is a marker of CVH and higher levels are associated with an adverse CV biomarker profile. Furthermore, CO-related biological pathways may contribute to the development of HF.