Lifetime risk estimates provide a comprehensive assessment of the population-level disease burden, while accounting for other competing risks such as mortality [1]. The overall lifetime risk estimates for HF are 20%-46% [2,3], but the lifetime risk estimates for HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) have not been studied.
In this study, the lifetime risks of HFrEF (LVEF <45%)and HFpEF (LVEF ≥45%) were calculated at selected ages, stratified by race, gender, and history of antecedent MI, using data from 2 large prospective cohort studies: the Cardiovascular Health Study (CHS) and the Multiethnic Study of Atherosclerosis (MESA) [4,5]. For the present analysis, all participants from the 2 studies were included, who were older than 45 years of age without prevalent HF at baseline.
The main participant characteristics of interest for the lifetime risk estimation were: age, gender, race, prevalent MI at baseline, and incident MI on follow-up antecedent to HF. The primary outcomes of interest were the incidence of overall HF and its subtypes, HFrEF and HFpEF.
The lifetime risks for HFpEF and HFrEF vary by gender, race, and history of antecedent MI: men have a higher risk of HFrEF compared with women, non-blacks have a higher risk of HFpEF compared with blacks, and MI patients have a higher risk of both HFpEF and HFrEF compared with individuals without MI. These findings may be helpful to develop more individualized prevention strategies.
1. Berry JD, Dyer A, Cai X, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366:321-9.
2. Huffman MD, Berry JD, Ning H, et al. Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project. J Am Coll Cardiol. 2013;61:1510-7.
3. Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing
congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068-72.
4. Bild DE, Bluemke DA, Burke GL, et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol.2002;156:871-81.
5. Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263-76.
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