van Essen Bart J, Emmens Johanna E, Tromp Jasper, Ouwerkerk Wouter, Smit Marcelle D, Geluk Christiane A, Baumhove Lukas, Suthahar Navin, Gansevoort Ron T, Bakker Stephan J L, Damman Kevin, van der Meer Peter, de Boer Rudolf A, van Veldhuisen Dirk J, Voors Adriaan A
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Saw Swee Hock School of Public Health & The National University Health System, Singapore, Singapore.
Eur Heart J. 2025 Apr 22;46(16):1528-1536. doi: 10.1093/eurheartj/ehae868.
Current estimates for the lifetime risk to develop heart failure with either a reduced (HFrEF) or preserved ejection fraction (HFpEF) and their associated risk factors are derived from two studies from the USA. The sex-specific lifetime risk and population attributable fraction of potentially modifiable risk factors for incident HFpEF and HFrEF are described in a large European community-based cohort with 25 years of follow-up.
A total of 8558 participants from the PREVEND cohort were studied at baseline from 1997 onwards and followed until 2022 for cases of new-onset HFrEF (ejection fraction < 50%) and HFpEF (ejection fraction ≥ 50%) by assessment of hospital records.
A total of 804 cases of new-onset HF were identified (534 HFrEF and 270 HFpEF) during 25 years of follow-up. The mean age at baseline was 50 years for men and 47 years for women. The mean age at onset of HF was 72.1 years in men and 74.2 years in women. The overall lifetime risk of developing HF was 24.5% in men compared to 23.3% in women. The lifetime risk of HFrEF was lower in women compared with men (11.9% vs. 18.1%), while the lifetime risk of HFpEF was higher in women compared with men (11.5% vs. 6.4%). In women, 71% of incident HFrEF cases were attributable to eight risk factors (hypertension, hypercholesterolaemia, obesity, smoking, atrial fibrillation, chronic kidney disease, myocardial infarction, and diabetes mellitus) and 60% in men. In women, 64% of incident HFpEF cases were attributable to those risk factors, whereas this was 46% in men. More specifically, in both men and women, hypertension and hypercholesterolaemia were the strongest risk factors for HFrEF, whereas hypertension and obesity were the strongest risk factors for HFpEF.
In this European cohort, the lifetime risk of developing HFrEF was greater in men than in women, while women were at greater risk of developing HFpEF. Eight directly and indirectly modifiable risk factors substantially accounted for the risk of developing HFrEF and HFpEF, particularly in women.
目前关于射血分数降低的心衰（HFrEF）或射血分数保留的心衰（HFpEF）发生的终生风险及其相关危险因素的估计值源自美国的两项研究。在一个有25年随访的大型欧洲社区队列中，描述了HFpEF和HFrEF事件潜在可改变危险因素的性别特异性终生风险和人群归因分数。
从1997年起对PREVEND队列中的8558名参与者进行基线研究，并通过评估医院记录随访至2022年，以确定新发HFrEF（射血分数<50%）和HFpEF（射血分数≥50%）病例。
在25年的随访期间，共识别出804例新发心衰病例（534例HFrEF和270例HFpEF）。男性基线平均年龄为50岁，女性为47岁。男性心衰发病的平均年龄为72.1岁，女性为74.2岁。男性发生心衰的总体终生风险为24.5%，女性为23.3%。女性HFrEF的终生风险低于男性（11.9%对18.1%），而女性HFpEF的终生风险高于男性（11.5%对6.4%）。在女性中，71%的新发HFrEF病例可归因于八个危险因素（高血压、高胆固醇血症、肥胖、吸烟、心房颤动、慢性肾脏病、心肌梗死和糖尿病），男性为60%。在女性中，64%的新发HFpEF病例可归因于这些危险因素，而男性为46%。更具体地说，在男性和女性中，高血压和高胆固醇血症是HFrEF的最强危险因素，而高血压和肥胖是HFpEF的最强危险因素。
在这个欧洲队列中，男性发生HFrEF的终生风险高于女性，而女性发生HFpEF的风险更高。八个直接和间接可改变的危险因素在很大程度上解释了发生HFrEF和HFpEF的风险，尤其是在女性中。
