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


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.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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.
Charles B
CB
Eaton
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.).
Mary
M
Pettinger
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.).
Jacques
J
Rossouw
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.).
Lisa Warsinger
LW
Martin
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.).
Randi
R
Foraker
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.).
Abdullah
A
Quddus
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.).
Simin
S
Liu
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.).
Nina S
NS
Wampler
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.).
Wen-Chih
WC
Hank Wu
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.).
JoAnn E
JE
Manson
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.).
Karen
K
Margolis
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.).
Karen C
KC
Johnson
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.).
Matthew
M
Allison
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.).
Giselle
G
Corbie-Smith
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.).
Wayne
W
Rosamond
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.).
Khadijah
K
Breathett
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.).
Liviu
L
Klein
heart failure; hospitalization; prevalence; public health; risk factors
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