HFpEF, HFrEF Lifetime Risks Have Been Identified

Men have a higher lifetime risk for heart failure with reduced ejection fraction (HFrEF) than women, and nonblacks have a higher risk for heart failure with preserved ejection fraction (HFpEF) than blacks, according to a new study.

The study aimed to pinpoint the lifetime risks for HFpEF and HFrEF, which were previously unknown.

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Data from 12,417 participants aged younger than 45 years in the Cardiovascular Health Study (CHS) and Multiethnic Study of Atherosclerosis (MESA) were analyzed using a modified Kaplan-Meier method.

HFpEF was defined as an ejection fraction of 45% or less, and HFrEF was defined at an ejection fraction as more than 45%. Participants with HF at baseline were excluded.

After a median follow-up of 11.6 years, 561 HFrEF events and 726 HFpEF events were reported.

Analysis showed that men had a higher lifetime risk for any HF through 90 years of age than women (27.4% vs 23.8%). Men also had a higher risk for HFrEF than women (10.6% vs 5.8%), but the risk was similar between men and women for HFpEF.

In a subanalysis stratifying race, nonblacks had a higher overall risk for HF than blacks (25.9% vs 22.4%). Nonblacks also had a higher risk for HFpEF than blacks (11.2% vs 7.7%), but the risk was similar between blacks and nonblacks for HFrEF.

Participants who had had a history of heart attack before HF diagnosis had a 2.5-fold higher risk for HFpEF and a 4-fold higher risk for HFrEF, compared with participants without a history of heart attack.

“Lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent myocardial infarction,” the researchers concluded. “These insights into the distribution of HF risk and its subtypes could inform the development of targeted strategies to improve population-level HF prevention and control.”

—Amanda Balbi

Reference:

Pandey A, Omar W, Ayers C, et al. Sex and race differences in lifetime risk of heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. Circulation. 2018;137:1814-1823. https://doi.org/10.1161/CIRCULATIONAHA.117.031622.

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