Sex differences in new-onset heart failure.
BACKGROUND
Sex differences in patients with established heart failure have been well described, but much less is known in the development of heart failure.


METHODS
We studied sex-specific incidence and risk of new-onset heart failure in 8592 subjects (mean age 49.2 ± 12.7 years; 50.1 % women) of the Prevention of REnal and Vascular ENdstage Disease (PREVEND) study and distinguished reduced and preserved ejection fraction (HFrEF <40 % and HFpEF >50 %).


RESULTS
Of 374 cases with incident heart failure, 241 (64.4 %) occurred in men and 133 (35.6 %) in women (median follow-up 12.5 years; 96,550 person-years). Men developed heart failure earlier (7.0 vs. 8.6 years; P < 0.001). Incidence rates per 1,000 person-years in women compared to men were lower for HFrEF (1.2 vs. 3.0 %; P < 0.001), but higher for HFpEF (1.2 vs. 0.7 %; P < 0.001). Women developed HFpEF later in life than HFrEF (75.1 vs. 69.7 years; P = 0.033), while men showed no significant difference (72.2 vs. 69.5 years; P = 0.116). Multivariable competing risks analyses showed that women had lower risk for HFrEF (subhazard ratio = 0.47; 95 % CI 0.29-0.76, P = 0.002) but higher risk for HFpEF (subhazard ratio = 2.16; 95 % CI 1.21-3.83, P = 0.009) than men. Among all risk factors, only atrial fibrillation had a sex-specific predictive value and increased risk specifically for women (P-for interaction = 0.016).


CONCLUSIONS
In a middle-aged population, men developed heart failure more frequently and at a younger age than women. However, women had higher risk for HFpEF, with atrial fibrillation being a specific female risk factor.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands, s.meyer@umcg.nl.
Sven
S
Meyer
Frank P
FP
Brouwers
Adriaan A
AA
Voors
Hans L
HL
Hillege
Rudolf A
RA
de Boer
Ron T
RT
Gansevoort
Pim
P
van der Harst
Michiel
M
Rienstra
Isabelle C
IC
van Gelder
Dirk J
DJ
van Veldhuisen
Wiek H
WH
van Gilst
Peter
P
van der Meer
D017677:Age Distribution; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment; D012727:Sex Characteristics; D017678:Sex Distribution