Background: Studies from Sweden have reported association between immigrant status and incidence of\r\ncardiovascular diseases. The nature of this relationship is unclear. We investigated the relationship between\r\nimmigrant status and risk of heart failure (HF) hospitalization in a population-based cohort, and to what extent this\r\nis mediated by hypertension and life-style risk factors. We also explored whether immigrant status was related to\r\ncase-fatality after HF.\r\nMethods: 26,559 subjects without history of myocardial infarction (MI), stroke or HF from the community-based\r\nMalm�¶ Diet and Cancer (MDC) cohort underwent a baseline examination during 1991-1996. Incidence of HF\r\nhospitalizations was monitored during a mean follow-up of 15 years.\r\nResults: 3,129 (11.8%) subjects were born outside Sweden. During follow-up, 764 subjects were hospitalized with\r\nHF as primary diagnosis, of whom 166 had an MI before or concurrent with the HF. After adjustment for potential\r\nconfounding factors, the hazard ratios (HR) for foreign-born were 1.37 (95% CI: 1.08-1.73, p = 0.009) compared to\r\nnative Swedes, for HF without previous MI. The results were similar in a secondary analysis without censoring at\r\nincident MI. There was a significant interaction (p < 0.001) between immigrant status and waist circumference\r\n(WC), and the increased HF risk was limited to immigrants with high WC. Although not significant foreign-born\r\ntended to have lower one-month and one-year mortality after HF.\r\nConclusions: Immigrant status was associated with long-term risk of HF hospitalization, independently of\r\nhypertension and several life-style risk factors. A significant interaction between WC and immigrant status on\r\nincident HF was observed.
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