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Heart Failure in Women--Insights from the Framingham Heart Study
Satish Kenchaiah1, Ramachandran S Vasan
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St., #532, Little Rock, AR, 72205, USA, SKenchaiah@uams.edu.
Insights
Heart failure incidence declined in women but not men. Despite improved survival, heart failure (HF) remains a leading cause of death, with cardiovascular issues dominating mortality in both sexes.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Heart failure (HF) incidence has decreased in women but not men since the late 20th century.
- Survival post-HF onset has improved, yet HF remains a highly lethal condition with a 5-year mortality exceeding 50%.
- Women exhibit a lower 8-year relative risk of HF compared to men.
Purpose of the Study:
- To analyze trends in heart failure incidence and survival.
- To compare HF incidence rates and risk factors between sexes.
- To investigate causes of death in heart failure patients.
Main Methods:
- Analysis of data from the Framingham Heart Study participants.
- Comparison of incidence rates for HF with preserved ejection fraction (HFPEF) and HF with reduced ejection fraction (HFREF) between men and women.
- Examination of risk factors like hypertension and diabetes, and biomarker associations with HF risk.
Main Results:
- Men have a 2-fold higher cumulative incidence of HFREF than HFPEF.
- Hypertension and diabetes mellitus contribute more significantly to HF risk in women.
- Cardiovascular causes account for the majority of underlying and immediate deaths in HF patients, with non-cardiovascular causes more prevalent in HFPEF.
Conclusions:
- While HF survival has improved, it remains a critical health issue with significant sex-based differences in incidence and risk factors.
- Understanding sex-specific risk factors and causes of death is crucial for targeted prevention and treatment strategies.
- HFPEF is associated with a higher proportion of non-cardiovascular mortality compared to HFREF.
Abstract:
In the latter half of the 20th century, among participants of the Framingham Heart Study, incidence of heart failure (HF) has declined by about a third in women but not in men and survival after the onset of HF has improved in both sexes; however, HF remains highly lethal with over 50% dying within 5 years after onset of HF. Overall, the 8-year relative risk of HF is 24% lower in women compared with men. The 8-year incidence rates of HF with preserved ejection fraction (HFPEF; EF >45%) and HF with reduced EF (HFREF; EF ≤ 45%) in women and HFPEF in men are similar; however, men have a 2-fold higher cumulative incidence of HFREF than HFPEF. The lifetime risk of HF is about 20% in both women and men at 40, 50, 60, 70, and 80 years of age. Contribution of hypertension and diabetes mellitus to the risk of HF was more prominent in women than in men. Serum levels of several biomarkers were distinctly different in women compared with men and had differential effects on left ventricular structure and function; however, the strength and direction of the association between biomarkers levels and HF risk were generally similar in women and men. In individuals with HF, about two-thirds of the underlying cause of death and about one-half of the immediate cause of death were due to cardiovascular causes. Non-cardiovascular underlying and immediate causes of death were more evident in HFPEF.
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