Men at Higher Lifetime Risk of Developing HFrEF While Women at Higher Risk of HFpEF
The lifetime risk of developing heart failure with reduced ejection fraction (HFrEF) is greater in men, while women are at greater risk of developing HF with preserved EF (HFpEF), according to 25-year results from the PREVEND study published Dec. 30 in the European Heart Journal.
The current study is an extension of the PREVEND community-based European cohort, which previously investigated risk factors for HFrEF and HFpEF development. Investigators looked at lifetime risk of developing HF, HFpEF and HFrEF as well as eight population-attributable fraction of potentially modifiable risk factors on the development of HF. The eight risk factors studied were hypertension, hypercholesterolemia, obesity, smoking, atrial fibrillation, chronic kidney disease, myocardial infarction and diabetes.
The study sample included 4,268 men and 4,290 women from the PREVEND cohort followed from 1997 to 2022. During a median follow-up of 23.4 years, 534 (6.2%) patients developed HFrEF, 270 (3.2%) developed HFpEF, and 1,657 died before they developed HF. The mean age at baseline was 50 years for men and 47 years for women, while mean age at onset of HF was 72.1 years and 74.2 years, respectively.
Results showed a similar overall lifetime risk of developing HF: 24.5% in men compared to 23.3% in women. For HFrEF, lifetime risk was lower in women vs. men (11.9% vs. 18.1%). For HFpEF, lifetime risk was higher in women vs. men (11.5% vs. 6.4%). In women, 71% of incident HFrEF cases were attributable to the eight risk factors vs. 60% in men. Additionally, in women, 64% of incident HFpEF cases were attributable to the risk factors vs. 46% in men. Specifically, hypertension and hypercholesterolemia were the strongest risk factors for developing HFrEF, whereas hypertension and obesity were the strongest risk factors for developing HFpEF.
The authors note the present results "convey a positive message, namely that the prevention and treatment of well-known risk factors may have the potential to substantially reduce cases of incident HF…in particular in women."
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure
Keywords: Heart Failure, Risk Factors, Myocardial Infarction