Sex-related differences in cardiovascular risk factor accumulation and incident heart failure: data from the PREVEND observational cohort

Abstract Purpose To examine whether cardiovascular risk factor development over time would associate differently with incident heart failure (HF) in women and men. Methods In the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort, we calculated the incidence rates (IR) of HF and cardiovascular risk factors using Poisson regression. We examined sex-related differences in relative rates of HF according to cardiovascular risk factor development using IR-ratio (IRR=IRrisk-factor/IRno-risk-factor) and Cox regression models. Results Among 8592 participants (mean age 49.8 years; 50.1% women), 241 men and 133 women developed HF over 12.5 (12.2–12.9) years, resulting in an overall HF incidence rate of 5.12 (per 1000 person-years) in men versus 2.69 in women. Men also had higher incidence rates of diabetes (IRmen: 7.23 vs IRwomen: 4.46), hypertension (IRmen: 27.93 vs IRwomen: 21.35) and myocardial infarction (IRmen: 3.73 vs IRwomen: 1.33). Relative rates of HF in individuals developing obesity, diabetes and MI were comparable in both sexes (P>0.05), but development of hypertension more strongly associated with incident HF in women (IRRwomen: 6.49; 95% CI: 3.04–13.87 vs IRRmen: 2.34; 95% CI: 1.38–3.95, P=0.030). Similar trends were observed in an adjusted Cox-regression model (women:men HR: 2.93; 95% CI: 1.15–7.45; p=0.024). Conclusions Cardiovascular risk factors develop more often in men and associate with higher absolute rates of HF in men. However, in individuals developing hypertension, the relative rate of HF is higher in women compared to men. Our results suggest that aggressive and sex-specific risk factor management may be helpful to prevent incident HF. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Netherlands Heart Foundation;Public EU grant - European Research Council