부산대학교 도서관

Introduction: Heart failure (HF) is a global epidemic that is common in aging populations.Hypothesis: There are gender differences in HF epidemiology and risk.Methods: In N=78,877 individuals without prevalent HF at baseline (median age 49.5 years, age range 39.6 to 59.4 years, 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-Sani, Northern Sweden), we examined gender differences in the association of incident HF with mortality, and the relation and attributable risks of classical risk factors, prevalent cardiovascular disease and biomarkers (C-reactive protein (CRP), N-terminal pro B-type natriuretic peptide (Nt-proBNP)) with HF incidence in women vs. men.Results: Over a median follow-up of 12.7 years, fewer HF cases were observed in women (N=2,410, 5.9%) than in men (N=2,789, 7.3%). Men had a worse cardiovascular risk factor profile and more prevalent cardiovascular disease. After HF onset, men had a higher mortality than women (P<0.001; multivariable-adjusted hazard ratio, 95% confidence interval: women: 6.34, 5.83-6.90; men: 6.74, 6.30-7.21). Multivariable-adjusted Cox models showed significant gender differences for the association of systolic blood pressure (P=0.0049), CRP (P=0.0014), Nt-proBNP (P=0.012), heart rate (P<0.001) and previous myocardial infarction or stroke (P=0.016) with incident HF. The population attributable risk of all risk factors combined was 58.3% in women and 63.7% in men. Overweight and obesity accounted for about 37% of women’s risk.Conclusions: HF risk was higher in men. HF onset dramatically increased mortality risk in both genders. Of the classical risk factors, BMI explained the largest proportion of HF risk. Prospective studies are needed to evaluate the observed gender differences for their role in gender-specific prevention approaches.Figure: Cox regressions for mortality and HF as time-dependent covariate (model 1); additional adjustment for classical risk factors (model 2).