Journal
JACC-HEART FAILURE
Volume 7, Issue 3, Pages 204-213Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2018.08.008
Keywords
biomarkers; cohort; epidemiology; heart failure; mortality; sex
Categories
Funding
- European Research Council under European Union Horizon 2020 research and innovation program [648131]
- German Ministry of Research and Education [BMBF 01ZX1408A]
- German Research Foundation Emmy Noether Program grant [SCHN 1149/3-1]
- European Union Seventh Framework Programme award FP7/2007-2013 under grants HEALTH-F2-2011 [278913]
- European Union FP 7 project CHANCES [HEALTHF3-2010-242244]
- Medical Research Council London [G0601463 (80983)]
- National Institute for Health and Welfare, Finland
- Pfizer Foundation
- Italian Ministry of University and Research-Programma Triennale di Ricerca, Decreto 1588
- Instrumentation Laboratory
- Norrbotten County Council
- Vasterbotten County Council
- Finnish Foundation for Cardiovascular Research
- Academy of Finland [139635]
- Swedish Heart-Lung Foundation [20140799, 20120631, 20100635]
- County Council of Vasterbotten grant [VLL-548791]
- Umea University
- German Center for Cardiovascular Research grant [81Z1710103, 81Z1710101]
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OBJECTIVES This study investigates differences between women and men in heart failure (HF) risk and mortality. BACKGROUND Sex differences in HF epidemiology are insufficiently understood. METHODS In 78,657 individuals (median 49.5 years of age; age range 24.1 to 98.7 years; 51.7% women) from community-based European studies (FINRISK, DanMONICA, Moli-sani, Northern Sweden) of the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium, the association between incident HF and mortality, the relationship of cardiovascular risk factors, prevalent cardiovascular diseases, biomarkers (C-reactive protein [CRP]; N-terminal pro-B-type natriuretic peptide [NT-proBNP]) with incident HF, and their attributable risks were tested in women vs. men. RESULTS Over a median follow-up of 12.7 years, fewer HF cases were observed in women (n = 2,399 [5.9%]) than in men (n = 2,771 [7.3%]). HF incidence increased markedly after 60 years of age, initially with a more rapid increase in men, whereas incidence in women exceeded that of men after 85 years of age. HF onset substantially increased mortality risk in both sexes. Multivariable-adjusted Cox models showed the following sex differences for the association with incident HF: systolic blood pressure hazard ratio (HR) according to SD in women of 1.09 (95% confidence interval [CI]: 1.05 to 1.14) versus HR of 1.19 (95% CI: 1.14 to 1.24) in men; heart rate HR of 0.98 (95% CI: 0.93 to 1.03) in women versus HR of 1.09 (95% CI: 1.04 to 1.13) in men; CRP HR of 1.10 (95% CI: 1.00 to 1.20) in women versus HR of 1.32 (95% CI: 1.24 to 1.41) in men; and NT-proBNP HR of 1.54 (95% CI: 1.37 to 1.74) in women versus HR of 1.89 (95% CI: 1.75 to 2.05) in men. Population-attributable risk of all risk factors combined was 59.0% in women and 62.9% in men. CONCLUSIONS Women had a lower risk for HF than men. Sex differences were seen for systolic blood pressure, heart rate, CRP, and NT-proBNP, with a lower HF risk in women. (C) 2019 by the American College of Cardiology Foundation.
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