Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project

Abstract

Objectives: This study sought to estimate lifetime risk for heart failure (HF) by sex and race.

Background: Prior estimates of lifetime risk for developing HF range from 20% to 33% in predominantly white cohorts. Short-term risks for HF appear higher for blacks than whites, but only limited comparisons of lifetime risk for HF have been made.

Methods: Using public-release and internal datasets from National Heart, Lung, and Blood Institute-sponsored cohorts, we estimated lifetime risks for developing HF to age 95 years, with death free of HF as the competing event, among participants in the CHA (Chicago Heart Association Detection Project in Industry), ARIC (Atherosclerosis Risk in Communities), and CHS (Cardiovascular Health Study) cohorts.

Results: There were 39,578 participants (33,652 [85%] white; 5,926 [15%] black) followed for 716,976 person-years; 5,983 participants developed HF. At age 45 years, lifetime risks for HF through age 95 years in CHA and CHS were 30% to 42% in white men, 20% to 29% in black men, 32% to 39% in white women, and 24% to 46% in black women. Results for ARIC demonstrated similar lifetime risks for HF in blacks and whites through age 75 years (limit of follow-up). Lifetime risk for HF was higher with higher blood pressure and body mass index at all ages in both blacks and whites, and did not diminish substantially with advancing index age.

Conclusions: These are among the first data to compare lifetime risks for HF between blacks and whites. Lifetime risks for HF are high and appear similar for black and white women, yet are somewhat lower for black compared with white men due to competing risks.

Figure 1a-d. Lifetime risks for heart failure in white and black Americans

Lifetime risks (LR) for heart failure at index age 45 years for black and white men (1a) and women (1b) in the Chicago Heart Association Detection in Industry Project (CHA) and Atherosclerosis Risk in Communities (ARIC) cohorts and LR for heart failure at index age 65 years for black and white men (1c) and women (1d) in the Cardiovascular Health Study (CHS).

Figure 1a-d. Lifetime risks for heart failure in white and black Americans

Lifetime risks (LR) for heart failure at index age 45 years for black and white men (1a) and women (1b) in the Chicago Heart Association Detection in Industry Project (CHA) and Atherosclerosis Risk in Communities (ARIC) cohorts and LR for heart failure at index age 65 years for black and white men (1c) and women (1d) in the Cardiovascular Health Study (CHS).

Figure 1a-d. Lifetime risks for heart failure in white and black Americans

Lifetime risks (LR) for heart failure at index age 45 years for black and white men (1a) and women (1b) in the Chicago Heart Association Detection in Industry Project (CHA) and Atherosclerosis Risk in Communities (ARIC) cohorts and LR for heart failure at index age 65 years for black and white men (1c) and women (1d) in the Cardiovascular Health Study (CHS).

Figure 1a-d. Lifetime risks for heart failure in white and black Americans

Lifetime risks (LR) for heart failure at index age 45 years for black and white men (1a) and women (1b) in the Chicago Heart Association Detection in Industry Project (CHA) and Atherosclerosis Risk in Communities (ARIC) cohorts and LR for heart failure at index age 65 years for black and white men (1c) and women (1d) in the Cardiovascular Health Study (CHS).

Figure 2a (men) and 2b (women). Lifetime and unadjusted risks for heart failure

Lifetime risks (LR) are compared with unadjusted risks for heart failure at index age 45 by sex-race group in the Chicago Heart Association Detection in Industry Project (CHA) Cohort. The difference between lifetime risk estimate and unadjusted cumulative incidence (Kaplan-Meier estimate) is an estimate of the competing risk for each sex/race group.