Introduction: Lifetime risk of HF has been estimated to range from 20% to 46% in diverse sex and race groups. However, lifetime risk estimates for the two HF phenotypes, HFpEF and HFrEF, have not been clearly defined.
Hypothesis: Lifetime risk of HFpEF and HFrEF will vary across different sex- and race-based groups.
Methods: Participant-level data from 2 large prospective cohort studies, CHS, and MESA, were pooled excluding individuals with prevalent HF. Remaining lifetime risk estimates for HFpEF (EF≥ 45%) and HFrEF (EF < 45%) were determined at different index ages using a modified Kaplan-Meier method with HF-free mortality and other HF subtype as competing risks.
Results: We included 12,417 participants older than 45 years age (22.2% blacks, 44.8% men) with 561 HFrEF & 726 HFpEF incident events over a median follow up of 12.1 years. At index age of 45y, the lifetime risk of overall HF through age 90 was higher in men than women. This was largely related to the higher risk of HFrEF in men than women. The lifetime risk of HFpEF was similar in men and women. Lifetime risks for HFpEF and HFrEF were similar in men. In contrast, women had higher risk of HFpEF than HFrEF (Table). In race-stratified analyses, lifetime risk for overall HF was higher in non-blacks than blacks. This was largely due to the higher lifetime risk of HFpEF in non-blacks than blacks. Lifetime risk of HFrEF was similar in blacks vs. non-blacks. Non-blacks had higher remaining lifetime risk for HFpEF than HFrEF. In contrast, the lifetime risks for the two HF subtypes in blacks were similar (Table). Among patients with antecedent MI, the remaining lifetime risks for HFpEF and HFrEF were 2.5-fold and 4-fold higher, respectively, as compared with those without antecedent MI.
Conclusion: Lifetime risks for HF subtypes vary by sex, race, and history of antecedent MI. These findings provide important insights into the distribution of risk for HF subtypes according to relevant population subgroups.