Objective Patients with heart failure have shorter mean leucocyte telomere length (LTL), a marker of biological age, compared with healthy subjects, but it is unclear whether this is of prognostic significance. We therefore sought to determine whether LTL is associated with outcomes in patients with heart failure.
Methods We measured LTL in patients with heart failure from the BIOSTAT-CHF Index (n=2260) and BIOSTAT-CHF Tayside (n=1413) cohorts. Cox proportional hazards analyses were performed individually in each cohort and the estimates combined using meta-analysis. Our co-primary endpoints were all-cause mortality and heart failure hospitalisation.
Results In age-adjusted and sex-adjusted analyses, shorter LTL was associated with higher all-cause mortality in both cohorts individually and when combined (meta-analysis HR (per SD decrease in LTL)=1.16 (95% CI 1.08 to 1.24); p=2.66×10−5), an effect equivalent to that of being four years older. The association remained significant after adjustment for the BIOSTAT-CHF clinical risk score to account for known prognostic factors (HR=1.12 (95% CI 1.05 to 1.20); p=1.04×10−3). Shorter LTL was associated with both cardiovascular (HR=1.09 (95% CI 1.00 to 1.19); p=0.047) and non-cardiovascular deaths (HR=1.18 (95% CI 1.05 to 1.32); p=4.80×10−3). There was no association between LTL and heart failure hospitalisation (HR=0.99 (95% CI 0.92 to 1.07); p=0.855).
Conclusion In patients with heart failure, shorter mean LTL is independently associated with all-cause mortality.
- heart failure
Data availability statement
Data are available on reasonable request.
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Contributors SPRR, VC, MN, CPN and NJS were responsible for project conceptualisation, methodology, formal data analyses and drafting the manuscript. MD, VC, AK, SDA, JGC, GF, DL, MM, MRI, WO, JtM, DJvV, FZ, LLN, PvdH, CCL, AV and NJS were responsible for data acquisition. All authors contributed to critical revision of the manuscript, approved the final version for publication and are accountable for all aspects of the work. SPRR and NJS are responsible for the overall content as guarantors.
Funding BIOSTAT-CHF was funded by a grant from the European Commission (FP7-242209-BIOSTAT-CHF).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Additional references w1-9 can be found in online supplemental file 1.
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