射血分数保留的心力衰竭和射血分数降低的心力衰竭的终生风险中的性别和种族差异。
Sex and Race Differences in Lifetime Risk of Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction.
机构信息
Division of Cardiology (A.P., W.O., C.A., J.D.B.).
Department of Clinical Sciences (C.A., J.D.B.).
出版信息
Circulation. 2018 Apr 24;137(17):1814-1823. doi: 10.1161/CIRCULATIONAHA.117.031622. Epub 2018 Jan 19.
BACKGROUND
Lifetime risk of heart failure has been estimated to range from 20% to 46% in diverse sex and race groups. However, lifetime risk estimates for the 2 HF phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), are not known.
METHODS
Participant-level data from 2 large prospective cohort studies, the CHS (Cardiovascular Health Study) and MESA (Multiethnic Study of Atherosclerosis), were pooled, excluding individuals with prevalent HF at baseline. Remaining lifetime risk estimates for HFpEF (EF ≥45%) and HFrEF (EF <45%) were determined at different index ages with the use of a modified Kaplan-Meier method with mortality and the other HF subtype as competing risks.
RESULTS
We included 12 417 participants >45 years of age (22.2% blacks, 44.8% men) who were followed up for median duration of 11.6 years with 2178 overall incident HF events with 561 HFrEF events and 726 HFpEF events. At the index age of 45 years, the lifetime risk for any HF through 90 years of age was higher in men than women (27.4% versus 23.8%). Among HF subtypes, the lifetime risk for HFrEF was higher in men than women (10.6% versus 5.8%). In contrast, 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% versus 22.4%). Among HF subtypes, the lifetime risk for HFpEF was higher in nonblacks than blacks (11.2% versus 7.7%), whereas that for HFrEF was similar across the 2 groups. Among participants with antecedent myocardial infarction before HF diagnosis, the remaining lifetime risks for HFpEF and HFrEF were up to 2.5-fold and 4-fold higher, respectively, compared with those without antecedent myocardial infarction.
CONCLUSIONS
Lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent myocardial infarction. These insights into the distribution of HF risk and its subtypes could inform the development of targeted strategies to improve population-level HF prevention and control.
背景
在不同性别和种族群体中，心力衰竭的终身风险估计范围为 20%至 46%。然而，HF 的两种表型（HFpEF 和 HFrEF）的终身风险估计值尚不清楚。
方法
来自 2 项大型前瞻性队列研究（心血管健康研究和动脉粥样硬化多民族研究）的参与者水平数据被汇总，排除基线时存在心力衰竭的患者。使用改良的 Kaplan-Meier 方法，将死亡率和其他心力衰竭亚型作为竞争风险，确定不同指数年龄时 HFpEF（EF≥45%）和 HFrEF（EF<45%）的剩余终身风险估计值。
结果
我们纳入了 12417 名年龄>45 岁的参与者（22.2%为黑人，44.8%为男性），中位随访时间为 11.6 年，共发生 2178 例心力衰竭事件，其中 561 例为 HFrEF 事件，726 例为 HFpEF 事件。在 45 岁的指数年龄时，90 岁时任何心力衰竭的终身风险在男性中高于女性（27.4%比 23.8%）。在心力衰竭亚型中，HFrEF 的终身风险在男性中高于女性（10.6%比 5.8%）。相比之下，HFpEF 的终身风险在男性和女性中相似。在种族分层分析中，非黑人的总体心力衰竭终身风险高于黑人（25.9%比 22.4%）。在心力衰竭亚型中，HFpEF 的终身风险在非黑人中高于黑人（11.2%比 7.7%），而 HFrEF 的终身风险在两组之间相似。在心力衰竭诊断前有心肌梗死病史的参与者中，HFpEF 和 HFrEF 的剩余终身风险分别高达 2.5 倍和 4 倍。
结论
HFpEF 和 HFrEF 的终身风险因性别、种族和心肌梗死的既往史而异。这些对心力衰竭风险及其亚型分布的了解可以为制定有针对性的策略以改善人群水平的心力衰竭预防和控制提供信息。
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