Sex and Race Differences in Lifetime Risk of Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction
Background—Lifetime risk of heart failure has been estimated to range from 20% to 46% in diverse sex and race groups. However, lifetime risk estimates for the two HF phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), is not known.
Methods—Participant-level data from 2 large prospective cohort studies, the Cardiovascular Health Study (CHS) and the Multiethnic Study of Atherosclerosis (MESA), were pooled excluding individuals with prevalent HF at baseline. Remaining lifetime risk estimates for HFpEF (Ejection Fraction ≥ 45%) and HFrEF (Ejection Fraction < 45%) were determined at different index ages using a modified Kaplan-Meier method with mortality and the other HF subtype as competing risks.
Results—We included 12,417 participants older than 45 years (22.2% blacks, 44.8% men) who were followed for median duration of 11.6 years with 2,178 overall incident HF events with 561 HFrEF events and 726 HFpEF events. At index age of 45 years, the lifetime risk for any HF through age 90 was higher in men than women (27.4% vs. 23.8%). Among HF subtypes, the lifetime risk for HFrEF was higher in men than women (10.6% vs. 5.8%). In contrast, the lifetime risk for HFpEF was similar in men and women. In race-stratified analyses, lifetime risk for overall HF was higher in non-blacks than blacks (25.9% vs. 22.4%). Among HF subtypes, the lifetime risk for HFpEF was higher in non-blacks than blacks (11.2% vs. 7.7%) while that for HFrEF was similar across the two groups. Among participants with antecedent myocardial infarction (MI) prior to HF diagnosis, the remaining lifetime risks for HFpEF and HFrEF were 2.5-fold and 4-fold higher, respectively, as compared with those without antecedent MI.
Conclusions—Lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent MI. These insights into the distribution of HF risk and its subtypes could inform development of targeted strategies to improve population level HF prevention and control.
- Heart failure with preserved ejection fraction
- Heart failure with reduced ejection fraction
- lifetime risk
- Received September 9, 2017.
- Revision received November 8, 2017.
- Accepted December 8, 2017.