Risk Factors for Incident Hospitalized Heart Failure With Preserved Versus Reduced Ejection Fraction in a Multiracial Cohort of Postmenopausal Women

Charles B Eaton; Mary Pettinger; Jacques Rossouw; Lisa Warsinger Martin; Randi Foraker; Abdullah Quddus; Simin Liu; Nina S Wampler; Wen-Chih Hank Wu; JoAnn E Manson; Karen Margolis; Karen C Johnson; Matthew Allison; Giselle Corbie-Smith; Wayne Rosamond; Khadijah Breathett; Liviu Klein

doi:10.1161/CIRCHEARTFAILURE.115.002883

Risk Factors for Incident Hospitalized Heart Failure With Preserved Versus Reduced Ejection Fraction in a Multiracial Cohort of Postmenopausal Women

Circ Heart Fail. 2016 Oct;9(10):e002883. doi: 10.1161/CIRCHEARTFAILURE.115.002883.

Authors

Charles B Eaton¹, Mary Pettinger², Jacques Rossouw², Lisa Warsinger Martin², Randi Foraker², Abdullah Quddus², Simin Liu², Nina S Wampler², Wen-Chih Hank Wu², JoAnn E Manson², Karen Margolis², Karen C Johnson², Matthew Allison², Giselle Corbie-Smith², Wayne Rosamond², Khadijah Breathett², Liviu Klein²

Affiliations

¹ From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.). charles_eaton@mhri.org.
² From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.).

PMID: 27682440
PMCID: PMC5111360
DOI: 10.1161/CIRCHEARTFAILURE.115.002883

Abstract

Background: Heart failure is an important and growing public health problem in women. Risk factors for incident hospitalized heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF) in women and differences by race/ethnicity are not well characterized.

Methods and results: We prospectively evaluated the risk factors for incident hospitalized HFpEF and HFrEF in a multiracial cohort of 42 170 postmenopausal women followed up for a mean of 13.2 years. Cox regression models with time-dependent covariate adjustment were used to define risk factors for HFpEF and HFrEF. Differences by race/ethnicity about incidence rates, baseline risk factors, and their population-attributable risk percentage were analyzed. Risk factors for both HFpEF and HFrEF were as follows: older age, white race, diabetes mellitus, cigarette smoking, and hypertension. Obesity, history of coronary heart disease (other than myocardial infarction), anemia, atrial fibrillation, and more than one comorbidity were associated with HFpEF but not with HFrEF. History of myocardial infarction was associated with HFrEF but not with HFpEF. Obesity was found to be a more potent risk factor for African American women compared with white women for HFpEF (P for interaction=0.007). For HFpEF, the population-attributable risk percentage was greatest for hypertension (40.9%) followed by obesity (25.8%), with the highest population-attributable risk percentage found in African Americans for these risk factors.

Conclusions: In this multiracial cohort of postmenopausal women, obesity stands out as a significant risk factor for HFpEF, with the strongest association in African American women.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.

Keywords: heart failure; hospitalization; prevalence; public health; risk factors.

Associated data

ClinicalTrials.gov/NCT00000611

Abstract

Associated data

Grants and funding