Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Luebeck, Germany.
Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland; National Institute for Health and Welfare, Helsinki, Finland.
JACC Heart Fail. 2019 Mar;7(3):204-213. doi: 10.1016/j.jchf.2018.08.008.
This study investigates differences between women and men in heart failure (HF) risk and mortality.
Sex differences in HF epidemiology are insufficiently understood.
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.
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.
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.
本研究旨在探讨女性和男性心力衰竭（HF）风险和死亡率的差异。
HF 流行病学中的性别差异尚未得到充分理解。
在来自欧洲社区基础研究（FINRISK、DanMONICA、Moli-sani、瑞典北部）的 BiomarCaRE（欧洲心血管风险评估生物标志物）联盟的 78657 名个体（中位数为 49.5 岁；年龄范围 24.1 至 98.7 岁；51.7%为女性）中，我们检验了事件性 HF 和死亡率之间的关联、心血管危险因素、已患心血管疾病、生物标志物（C 反应蛋白[CRP]；氨基末端 B 型利钠肽前体[NT-proBNP]）与事件性 HF 的关系及其在女性与男性中的归因风险。
在中位随访 12.7 年后，女性（n=2399[5.9%]）的 HF 病例少于男性（n=2771[7.3%]）。HF 发病率在 60 岁后显著增加，最初男性增加更快，而女性在 85 岁后发病率超过男性。HF 发作大大增加了两性的死亡率风险。多变量调整的 Cox 模型显示，与事件性 HF 相关的性别差异如下：女性的收缩压危险比（HR）为每标准差 1.09（95%置信区间[CI]：1.05 至 1.14），而男性为 1.19（95% CI：1.14 至 1.24）；女性的心率 HR 为 0.98（95% CI：0.93 至 1.03），而男性为 1.09（95% CI：1.04 至 1.13）；女性的 CRP HR 为 1.10（95% CI：1.00 至 1.20），而男性为 1.32（95% CI：1.24 至 1.41）；女性的 NT-proBNP HR 为 1.54（95% CI：1.37 至 1.74），而男性为 1.89（95% CI：1.75 至 2.05）。所有危险因素综合的人群归因风险在女性中为 59.0%，在男性中为 62.9%。
女性 HF 风险低于男性。在收缩压、心率、CRP 和 NT-proBNP 方面存在性别差异，女性 HF 风险较低。
