No abstract

Background Heart Failure (HF) is an important and growing public health problem in women. Risk factors for incident hospitalized HF with preserved (HFpEF) compared to reduced ejection fraction (HFrEF) in women, and differences by race/ethnicity, are not well characterized. Methods and Results We prospectively evaluated the risk factors for incident hospitalized HFpEF and HFrEF in a multi-racial cohort of 42,170 post-menopausal women followed 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 regarding incidence rates, baseline risk factors and their population attributable risk percentage (PAR%) were analyzed. Risk factors for both HFpEF and HFrEF were as follows: older age, Caucasian race, diabetes, cigarette smoking, and hypertension. Obesity, history of coronary heart disease (other than myocardial infarction (MI)), anemia, atrial fibrillation and more than one co-morbidity, were associated with HFpEF but not HFrEF. History of MI was associated with HFrEF but not HFpEF. Obesity was found to be a more potent risk factor for African American women compared with Caucasian women for HFpEF (p for interaction= 0.007). For HFpEF, the PAR% was greatest for hypertension (40.9%) followed by obesity (25.8%), with the highest PAR% found in African Americans for these risk factors. Conclusions In this multi-racial cohort of postmenopausal women, obesity stands out as a significant risk factor for HFpEF, with the strongest association in African American women. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.