TOPLINE

Among adults with congenital heart disease (CHD), coronary artery disease, sleep apnoea, depression, and current smoking were independently associated with a higher risk for late all-cause mortality, as were older age, male sex, and greater lesion complexity; however, higher income was associated with a lower risk.

METHODOLOGY

• Drawing on data from a large tertiary adult CHD referral centre, researchers conducted a retrospective cohort study to evaluate the association between acquired cardiovascular risk factors and all-cause mortality among 9826 adult patients with CHD (mean age, 39.0 years; 50.3% men) between 2000 and 2024.
• Patients were classified on the basis of CHD diagnosis and anatomic complexity. Diagnoses included atrial and ventricular septal defects, tetralogy of Fallot, Eisenmenger syndrome, and Fontan circulation.
• Demographic, congenital, metabolic, lifestyle, psychosocial, and socioeconomic profiles and acquired comorbidity data were collected at the first comprehensive clinical assessment.
• Acquired comorbidities — including hypertension, hypercholesterolaemia, diabetes, coronary artery disease, sleep apnoea, and depression — were identified from documented clinical diagnoses in medical records or clinic correspondence.
• The primary outcome was all-cause mortality. Patients were followed up over a median duration of 10.0 years.

TAKEAWAY

• During follow-up, 1371 patients died, corresponding to an overall mortality rate of 1.39% per patient-year.
• In the multivariable analysis, older age (hazard ratio [HR], 1.07), male sex (HR, 1.30), greater lesion complexity (HR, 2.12), and current smoking (HR, 1.67; P < .05 for all) were independently associated with a higher risk for all-cause mortality.
• Among acquired comorbidities, coronary artery disease (HR, 1.78), sleep apnoea (HR, 2.22), and depression (HR, 1.45; P < .05 for all) were independently associated with a higher risk for all-cause mortality; however, hypertension, hypercholesterolaemia, and diabetes were not.
• Higher income was associated with a lower risk for all-cause mortality (HR, 0.85; P = .002).

IN PRACTICE

"Taken together, this study reinforces that comprehensive ACHD [adult CHD] care should not be limited to lesion-specific surveillance, such as ventricular function, valves, and arrhythmias. ACHD cardiologists should ensure that acquired cardiovascular comorbidities and modifiable lifestyle-related exposures are actively recognized and addressed, either within specialized ACHD services or through close collaborations with primary care physicians and other relevant specialists," the researchers wrote.

SOURCE

The study was led by Masahiko Umei, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK. It was published online on October 06, 2026, in European Heart Journal.

LIMITATIONS

The retrospective study design left the possibility of residual confounding. The cohort was derived from a single tertiary centre, which may have limited the generalisability of the findings. The reliance on documented clinical diagnoses may have underestimated some comorbidities.

DISCLOSURES

The study did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors. One author received an overseas study grant from the Japan Society for the Promotion of Science. Two authors served on the editorial board of European Heart Journal but were not involved in handling this paper.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.