Author + information
- Received May 3, 2018
- Revision received August 13, 2018
- Accepted August 28, 2018
- Published online February 25, 2019.
- Christina Magnussen, MDa,b,
- Teemu J. Niiranen, MD, PhDc,f,
- Francisco M. Ojeda, PhDa,
- Francesco Gianfagna, MD, PhDd,e,
- Stefan Blankenberg, MDa,b,
- Erkki Vartiainen, MD, PhDf,
- Susana Sans, MD, PhDg,
- Gerard Pasterkamp, MD, PhDh,
- Maria Hughes, PhDi,
- Simona Costanzo, PhDd,
- Maria Benedetta Donati, MD, PhDd,
- Pekka Jousilahti, MD, PhDf,
- Allan Linneberg, MD, PhDj,k,l,
- Tarja Palosaari, MScf,
- Giovanni de Gaetano, MD, PhDd,
- Martin Bobak, MD, MSc, PhDm,
- Hester M. den Ruijter, PhDn,
- Torben Jørgensen, MD, PhDj,l,o,
- Stefan Söderberg, MD, PhDp,
- Kari Kuulasmaa, PhDf,
- Tanja Zeller, PhDa,b,
- Licia Iacoviello, MD, PhDd,e,
- Veikko Salomaa, MD, PhDf,
- Renate B. Schnabel, MD, MSca,b,∗ (, )
- on behalf of the BiomarCaRE Consortium
- aDepartment of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- bGerman Center for Cardiovascular Research, partner site Hamburg/Kiel/Luebeck, Germany
- cDivision of Medicine, Turku University Hospital and University of Turku, Turku, Finland
- dDepartment of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- eCentre for Research in EPIdemiology and preventive MEDicine (EPIMED) Department of Medicine and Surgery, University of Insubria, Varese, Italy
- fNational Institute for Health and Welfare, Helsinki, Finland
- gCatalan Department of Health, Barcelona, Spain
- hDepartment of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
- iCenter of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, Northern Ireland
- jCentre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
- kDepartment of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
- lDepartment of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- mDepartment of Epidemiology and Public Health, University College London, London, United Kingdom
- nLaboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- oFaculty of Medicine, University of Aalborg, Aalborg, Denmark
- pDepartment of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, Sweden
- ↵∗Address for correspondence:
Dr. Renate B. Schnabel, University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
Objectives This study investigates differences between women and men in heart failure (HF) risk and mortality.
Background Sex differences in HF epidemiology are insufficiently understood.
Methods In 78,657 individuals (median 49.5 years of age; age range 24.1 to 98.7 years; 51.7% women) from community-based European studies (FINRISK, DanMONICA, Moli-sani, Northern Sweden) of the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium, the association between incident HF and mortality, the relationship of cardiovascular risk factors, prevalent cardiovascular diseases, biomarkers (C-reactive protein [CRP]; N-terminal pro–B-type natriuretic peptide [NT-proBNP]) with incident HF, and their attributable risks were tested in women vs. men.
Results Over a median follow-up of 12.7 years, fewer HF cases were observed in women (n = 2,399 [5.9%]) than in men (n = 2,771 [7.3%]). HF incidence increased markedly after 60 years of age, initially with a more rapid increase in men, whereas incidence in women exceeded that of men after 85 years of age. HF onset substantially increased mortality risk in both sexes. Multivariable-adjusted Cox models showed the following sex differences for the association with incident HF: systolic blood pressure hazard ratio (HR) according to SD in women of 1.09 (95% confidence interval [CI]: 1.05 to 1.14) versus HR of 1.19 (95% CI: 1.14 to 1.24) in men; heart rate HR of 0.98 (95% CI: 0.93 to 1.03) in women versus HR of 1.09 (95% CI: 1.04 to 1.13) in men; CRP HR of 1.10 (95% CI: 1.00 to 1.20) in women versus HR of 1.32 (95% CI: 1.24 to 1.41) in men; and NT-proBNP HR of 1.54 (95% CI: 1.37 to 1.74) in women versus HR of 1.89 (95% CI: 1.75 to 2.05) in men. Population-attributable risk of all risk factors combined was 59.0% in women and 62.9% in men.
Conclusions Women had a lower risk for HF than men. Sex differences were seen for systolic blood pressure, heart rate, CRP, and NT-proBNP, with a lower HF risk in women.
Supported by European Research Council under European Union Horizon 2020 research and innovation program grant 648131; German Ministry of Research and Education grant BMBF 01ZX1408A; and German Research Foundation Emmy Noether Program grant SCHN 1149/3-1 (to Dr. Schnabel). The BiomarCaRE Project was funded by European Union Seventh Framework Programme award FP7/2007–2013 under grants HEALTH-F2-2011 to 278913. MORGAM Data Center is supported by European Union FP 7 project CHANCES (HEALTHF3-2010–242244). Funding was also provided by Medical Research Council London grant G0601463 (80983) for biomarkers in the MORGAM populations. FINRISK surveys were funded by National Institute for Health and Welfare, Finland; and by additional funding from numerous nonprofit foundations. DanMONICA cohorts at the Research Center for Prevention and Health were established over a period of 10 years and supported by numerous sources acknowledged in the original articles. The Moli-sani study was supported by grants from Pfizer Foundation, Italian Ministry of University and Research–Programma Triennale di Ricerca, Decreto 1588, and Instrumentation Laboratory. The Northern Sweden MONICA project was supported by Norrbotten and Västerbotten County Councils. Dr. Salomaa was supported by Finnish Foundation for Cardiovascular Research and Academy of Finland grant 139635; and has received honoraria for conference and advisory board participation from Novo Nordisk. Dr. Söderberg was supported by Swedish Heart-Lung Foundation grants 20140799, 20120631, and 20100635; County Council of Västerbotten grant VLL-548791; and by Umeå University. Dr. Schnabel was supported by German Center for Cardiovascular Research grant 81Z1710103. Dr. Zeller was supported by German Center for Cardiovascular Research grant 81Z1710101. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2018.
- Revision received August 13, 2018.
- Accepted August 28, 2018.
- 2019 American College of Cardiology Foundation
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