Researchers ID risk of heart failure subtypes by gender, race

Men are more prone to develop heart failure with reduced ejection fraction (HFrEF) than women but both sexes are equally likely to have heart failure with preserved ejection fraction (HFpEF), according to research published Jan. 19 in Circulation.

Earlier studies have reported heart failure lifetime risk estimates from 20 to 46 percent, but no previous investigation has analyzed the lifetime risk of HFrEF and HFpEF separately, wrote lead researcher Ambarish Pandey, MD, with the division of cardiology at University of Texas Southwestern Medical Center, and colleagues.

“This is particularly important since the two HF subtypes differ considerably in the demographic distribution, underlying pathophysiological mechanisms, and available preventive and therapeutic options,” Pandey et al. wrote. “Furthermore, recent studies have also identified distinct risk factors that may differentially predict risk for HFpEF and HFrEF, highlighting the need for more targeted, subtype-specific approaches to prevention.”

The researchers pooled two studies containing more than 12,000 participants to estimate the risk of these heart failure subtypes by gender and race. The combined cohort was 22.2 percent black and 55.2 percent women, and was followed for a median 11.6 years. All patients were older than 45 and without prevalent heart failure at baseline.

Pandey et al. tracked the individuals’ incident heart failure events and plotted the remaining lifetime risk estimates for HFpEF and HFrEF using a modified Kaplan-Meier method, with mortality and the other heart failure subtype as competing risks.

They found:

• The lifetime risk for any heart failure through age 90 was higher in men than women (27.4 percent vs. 23.8 percent), but that difference was driven by a 1.8-fold risk of HFrEF. The likelihood of HFpEF was similar in both genders.
• The chance of developing HFrEF was similar in blacks and non-blacks, while the odds of HFpEF were 11.2 percent in non-blacks versus 7.7 percent in blacks.
• Patients suffering myocardial infarction (MI) had 2.5 times the risk of developing HFpEF by age 90 and four times the risk of developing HFrEF.
• The risk for HFrEF was 1.6-fold higher in people with diabetes versus no diabetes, but the risk of HFpEF was similar.

“Among the HF subtypes, the burden of HFpEF is increasing in the community more so than HFrEF and novel approaches to its prevention are urgently needed,” Pandey and coauthors wrote. “Our study findings provide insights into the lifetime risk of HF subtypes across relevant population subgroups. These data may guide health policy makers and public health investigators to predict the relative population burden of the two distinct HF subtypes. It will also help identify the high-risk patient population for HFrEF and HFpEF and allow for appropriate disease-specific resource allocation and targeting of preventive strategies.”

Higher lifetime risk of HFrEF in men may be related to the increased prevalence and earlier onset of coronary heart disease in men than women, the researchers said. However, the researchers also pointed out men had a high burden of HFpEF equal to women, which “contrasts with the prevailing notion that HFpEF is predominantly a disease of women.”

Also, because HFpEF tends to occur at a later age than HFrEF, the researchers noted blacks may have lower rates of HFpEF due to shorter life expectancy.

Pandy and colleagues pointed out they included patients from two studies with different entry criteria, which may have affected risk estimates in the pooled population.