European Primary Care Cardiovascular Society

HF subtypes have different lifetime risks when stratified by gender, race and previous MI

Sex and Race Differences in Lifetime Risk of Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction

Pandey A, Omar W, Ayers C, et al. - Circulation 2018; published online ahead of print


Lifetime risk estimates provide a comprehensive assessment of the population-level disease burden, while accounting for other competing risks such as mortality [1]. The overall lifetime risk estimates for HF are 20%-46% [2,3], but the lifetime risk estimates for HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) have not been studied.

In this study, the lifetime risks of HFrEF (LVEF <45%)and HFpEF (LVEF ≥45%) were calculated at selected ages, stratified by race, gender, and history of antecedent MI, using data from 2 large prospective cohort studies: the Cardiovascular Health Study (CHS) and the Multiethnic Study of Atherosclerosis (MESA) [4,5]. For the present analysis, all participants from the 2 studies were included, who were older than 45 years of age without prevalent HF at baseline.

The main participant characteristics of interest for the lifetime risk estimation were: age, gender, race, prevalent MI at baseline, and incident MI on follow-up antecedent to HF. The primary outcomes of interest were the incidence of overall HF and its subtypes, HFrEF and HFpEF.

Main results


The lifetime risks for HFpEF and HFrEF vary by gender, race, and history of antecedent MI: men have a higher risk of HFrEF compared with women, non-blacks have a higher risk of HFpEF compared with blacks, and MI patients have a higher risk of both HFpEF and HFrEF compared with individuals without MI. These findings may be helpful to develop more individualized prevention strategies.


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Find this article online at Circulation 2018