1. Pre-term birth was associated with significantly increased risk of adult-onset heart failure, particularly among those 18 to 43 years of age.
Evidence Rating Level: 2 (Good)
Preterm birth is a known risk factor for early-life heart failure (HF). However, less is known about its association with adult-onset HF. This Swedish national cohort study aimed to investigate this association among all singleton live births from 1973 to 2014. HF was defined as any recorded diagnosis through 2015. A total of 4,193,069 individuals (median age = 22.5 years) were included and 4,158 (0.1%) were diagnosed with HF at some point during the study time frame (median [IQR] age at diagnosis = 15.4 [28.0] years). A gestational age of ≤37 weeks (preterm birth) aligned with previous findings and was associated with increased risk of HF at ages ≤1 year (adjusted HR = 4.49, 95% CI 3.86 to 5.22), compared with full-term birth. Among those 18 to 43 years of age, HRs were 4.72 (95% CI 2.11 to 10.52) for extremely preterm births (22 to 27 weeks), 1.92 (95% CI 1.37 to 2.71) for moderately preterm (28 to 33 weeks), 1.24 (95% CI 1.00 to 1.54) for late preterm (34 to 36 weeks), and 1.09 (95% CI 0.97 to 1.24) for early term (37 to 38 weeks). HF incidence rates for ages 18 to 43 years, across these stratified gestational ages, were 31.7, 13.8, 8.7, and 7.3, respectively, with associations persisting after removal of individuals with structural congenital cardiac anomalies. These associations, particularly among ages 18 to 43 years, were largely explained by shared familial determinants of HF and preterm birth. Overall, preterm birth was associated with a significantly increased risk of adult-onset HF. Those experiencing preterm birth may require closer follow-up as they progress into adulthood to reduce their risk for HF.
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