Sex and Race Differences in Lifetime Risk of HFpEF vs. HFrEF

Study Questions:

What are the lifetime risks of heart failure (HF) in patients with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)?


The study cohort was comprised of individuals who participated in two large prospective studies (excluding those with prevalent HF at baseline), the Cardiovascular Health Study (CHS; with n = 5,888) and the Multiethnic Study of Atherosclerosis (MESA; with n = 6,814). The study authors determined remaining lifetime risk estimates for HFpEF (EF >45%) and HFrEF (EF <45%) at different index ages using life-table analysis and a modified Kaplan-Meier method with mortality and the other HF subtype as competing risks. The main participant characteristics of interest for the lifetime risk estimation were: age (years), gender (men vs. women), ethnicity (nonblacks vs. blacks), prevalent myocardial infarction (MI) at baseline (yes vs. no), and incident MI on follow-up antecedent to HF (yes vs. no).


The study authors included 12,417 participants, age >45 years (22.2% blacks, 44.8% men), who were followed for a median duration of 11.6 years, with 2,178 overall incident HF events with 561 HFrEF events and 726 HFpEF events.

In sex-stratified analyses, at an 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 1.8-fold higher in men than women (10.6% vs. 5.8%), whereas the lifetime risk for HFpEF was similar in men and women.

In race-stratified analyses, lifetime risk for overall HF was higher in nonblacks than blacks (25.9% vs. 22.4%). Among HF subtypes, the lifetime risk for HFpEF was 1.5-fold higher in nonblacks than blacks (11.2% vs. 7.7%), while that for HFrEF was similar across the two groups.

Among participants with antecedent MI prior to HF diagnosis, the remaining lifetime risk of overall HF was 2.5-fold higher, and for HFpEF and HFrEF were 2.5-fold and 4-fold higher, respectively, as compared with those without antecedent MI.


These authors concluded that lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent MI.


As the longevity of the overall population increases, the natural history of patients with HF continues to evolve. This study is important because it captures factors that currently impact the natural history of HF. As the authors point out, this knowledge should help in better allocation of resources to prevent HF in the at-risk population.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Chronic Heart Failure

Keywords: African Americans, Heart Failure, Heart Failure, Diastolic, Heart Failure, Systolic, Myocardial Infarction, Risk, Secondary Prevention, Sex Characteristics, Stroke Volume

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