Clin Res Cardiol 107, Suppl 1, April 2018

Sex-specific Epidemiology of Heart Failure Risk and Mortality in Europe: Results from the BiomarCaRE Consortium
C. Magnussen1, F. Ojeda-Echevarria1, T. J. Niiranen2, F. Gianfagna3, S. Blankenberg1, E. Vartiainen2, S. Sans4, G. Pasterkamp5, M. F. Hughes6, S. Costanzo3, M. B. Donati3, P. Jousilahti2, A. Linneberg7, T. Palosaari2, G. de Gaetano3, M. Bobak8, H. M. den Ruijter9, T. Jørgensen10, S. Söderberg11, K. Kuulasmaa2, T. Zeller1, L. Iacoviello12, V. Salomaa2, R. Schnabel1, für die Studiengruppe: BiomarCaRE
1Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg GmbH, Hamburg; 2National Institute for Health and Welfare, Helsinki, FI; 3IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, IT; 4Catalan Department of Health, Barcelona, ES; 5Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, NL; 6Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, IE; 7Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen,, Copenhagen, DK; 8Department of Epidemiology and Public Health, University College London, London, UK; 9Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, NL; 10Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DK; 11Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, SE; 12Department of Medicine and Surgery, University of Insubria, Varese, IT;

BACKGROUND: Heart failure (HF) is a global epidemic and common in aging populations. Differences between sexes in HF epidemiology and mortality are insufficiently understood.

METHODS: We evaluated sex differences in HF in 78,657 individuals without prevalent HF at baseline (median age 49.5 years, 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 consortium. The association of incident HF with mortality, the relation of cardiovascular risk factors, prevalent cardiovascular diseases and biomarkers (C-reactive protein, CRP; N-terminal pro B-type natriuretic peptide, Nt-proBNP) and their attributable risks with HF incidence 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%). Women had a more preferable cardiovascular risk factor profile and fewer prevalent cardiovascular diseases than men. HF incidence increased markedly after the age of 60 years in both sexes, initially with a more rapid increase in men, while women exceeded men after age 85. HF onset substantially increased mortality risk in both sexes.

Multivariable-adjusted Cox models showed sex differences for the association with incident HF: systolic blood pressure, hazard ratio (HR) per standard deviation in women 1.09 (1.05-1.14) vs. 1.19 (95% CI 1.14-1.24) in men; heart rate 0.98 (0.93-1.03) in women vs. 1.09 (1.04-1.13) in men; CRP 1.10 (1.00-1.20) in women vs. 1.32 (1.24-1.41) in men; and Nt-proBNP 1.51 (1.35-1.69) in women vs. 1.81 (1.68-1.95) in men.

The population-attributable risk of all risk factors combined was 59.0% in women, 62.9% in men. Overweight and obesity accounted for about 37% of women’s attributable risk, for 27% in men.

CONCLUSIONS: Women had a lower HF risk than men. Sex differences were seen for systolic blood pressure, heart rate, CRP and Nt-proBNP with a lower risk of HF in women and may indicate different pathophysiological mechanisms. Classical risk factors explained only a moderate proportion of the population-attributable risk, but could serve as first targets for prevention in both sexes.