• Christina Magnussen, Teemu J Niiranen, Francisco M Ojeda, Francesco Gianfagna, Stefan Blankenberg, Erkki Vartiainen, Susana Sans, Gerard Pasterkamp, Maria Hughes, Simona Costanzo, Maria Benedetta Donati, Pekka Jousilahti, Allan Linneberg, Tarja Palosaari, Giovanni de Gaetano, Martin Bobak, Hester M den Ruijter, Torben Jørgensen, Stefan Söderberg, Kari Kuulasmaa, Tanja Zeller, Licia Iacoviello, Veikko Salomaa, Renate B Schnabel, and BiomarCaRE Consortium.
• Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Luebeck, Germany.
• JACC Heart Fail. 2019 Mar 1; 7 (3): 204-213.

ObjectivesThis study investigates differences between women and men in heart failure (HF) risk and mortality.BackgroundSex differences in HF epidemiology are insufficiently understood.MethodsIn 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.ResultsOver 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.ConclusionsWomen 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.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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