{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:10:52Z","timestamp":1791587452515,"version":"4.3.4"},"reference-count":36,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2023ZD0501803"],"award-info":[{"award-number":["2023ZD0501803"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key Science and Technology Project of the Prevention and Treatment of Major Diseases","award":["2022ZDZX0021"],"award-info":[{"award-number":["2022ZDZX0021"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,16]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To identify comorbidities associated with incident heart failure with preserved ejection fraction (HFpEF) and quantify their HRs for early risk stratification and prevention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>PROSPERO-registered (CRD42024505533) systematic review and meta-analysis. Primary analysis prioritised unadjusted HRs; exploratory analysis incorporated adjusted HRs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data sources<\/jats:title>\n                  <jats:p>Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials through 15 June 2025.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Eligibility criteria for selecting studies<\/jats:title>\n                  <jats:p>Cohort studies of adults (\u226518 years) without prior HF reporting HRs for incident HFpEF-associated comorbidities. Exclusions: non-English publications, reviews, non-clinical studies and studies without HR data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data extraction and synthesis<\/jats:title>\n                  <jats:p>Two reviewers independently extracted data and assessed quality (Newcastle-Ottawa Scale). Random-effects models pooled HRs. Heterogeneity was investigated using Galbraith\/Baujat plots, meta-regression and subgroup analyses. Publication bias assessed via funnel plots, Egger\u2019s and Begg\u2019s tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 61 eligible studies, 22 reporting unadjusted HRs formed the primary analysis, identifying five comorbidities with significant incident HFpEF risk: atrial fibrillation (AF) (HR 2.92, 95%\u2009CI 1.94 to 4.37, I\u00b2=86.6%), hypertension (HR 2.28, 95%\u2009CI 1.35 to 3.84, I\u00b2=96.9%), diabetes (HR 1.88, 95%\u2009CI 1.54 to 2.30, I\u00b2=58.2%), obesity (HR 1.70, 95%\u2009CI 1.45 to 2.00, I\u00b2=69.7%) and myocardial infarction (MI) (HR 1.62, 95%\u2009CI 1.18 to 2.23, I\u00b2=72.1%). Conversely, chronic kidney disease (CKD) (HR 1.44, 95%\u2009CI 0.68 to 3.06, I\u00b2=86.6%) and cerebrovascular disease (HR 1.72, 95%\u2009CI 0.93 to 3.18, I\u00b2=77.2%) showed non-significant associations. Exploratory analysis integrating unadjusted HRs from primary studies and adjusted HRs from 39 additional studies confirmed these five comorbidities as significant risk factors, with CKD again demonstrating non-significant association.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>AF, hypertension, diabetes, obesity and MI constitute evidence-based targets for HFpEF risk stratification and preventive management. The CKD-HFpEF association requires validation in larger cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42024505533.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-093306","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T09:01:17Z","timestamp":1754038877000},"page":"e093306","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Comorbidities and incidence of heart failure with preserved ejection fraction: a systematic review and meta-analysis of cohort studies"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4032-075X","authenticated-orcid":false,"given":"Linlong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Geriatrics and National Clinical Research Center for Geriatrics, 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