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. 2022 Feb 1;79(4):355-368.
doi: 10.1016/j.jacc.2021.11.024.

Race- and Gender-Based Differences in Cardiac Structure and Function and Risk of Heart Failure

Alvin Chandra  1 , Hicham Skali  2 , Brian Claggett  2 , Scott D Solomon  2 , Joseph S Rossi  3 , Stuart D Russell  4 , Kunihiro Matsushita  5 , Dalane W Kitzman  6 , Suma H Konety  7 , Thomas H Mosley  8 , Patricia P Chang  3 , Amil M Shah  9
Affiliations

Race- and Gender-Based Differences in Cardiac Structure and Function and Risk of Heart Failure

Alvin Chandra et al. J Am Coll Cardiol. .

Abstract

Background: Although heart failure (HF) risk and cardiac structure/function reportedly differ according to race and gender, limited data exist in late life when risk of HF is highest.

Objectives: The goal of this study was to evaluate race/gender-based differences in HF risk factors, cardiac structure/function, and incident HF in late life.

Methods: This analysis included 5,149 HF-free participants from ARIC (Atherosclerosis Risk In Communities), a prospective epidemiologic cohort study, who attended visit 5 (2011-2013) and underwent echocardiography. Participants were subsequently followed up for a median 5.5 years for incident HF/death.

Results: Patients' mean age was 75 ± 5 years, 59% were women, and 20% were Black. Male gender and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater left ventricular wall thickness and concentricity, differences that persisted after adjusting for cardiovascular comorbidities. After adjusting for cardiovascular comorbidities, men were at higher risk for HF and heart failure with reduced ejection fraction (HFrEF) in Black participants compared with White participants (HF: HR of 2.36 [95% CI: 1.37-4.08] vs 1.16 [95% CI: 0.89-1.51], interaction P = 0.016; HFrEF: HR of 3.70 [95% CI: 1.72-7.95] vs 1.55 [95% CI: 1.01-2.37] respectively, interaction P = 0.039). Black race was associated with a higher incidence of HF overall and HFrEF in men only (HF: 1.65 [95% CI: 1.07-2.53] vs 0.76 [95% CI: 0.49-1.17]; HFrEF: HR of 2.55 [95% CI: 1.46-4.44] vs 0.91 [95% CI: 0.46-1.83]). No race/gender-based differences were observed in risk of incident heart failure with preserved ejection fraction.

Conclusions: Among older persons free of HF, men and Black participants exhibit worse systolic performance and are at heightened risk for HFrEF, whereas the risk of heart failure with preserved ejection fraction is similar across gender and race groups.

Keywords: echocardiography; elderly; gender; heart failure; race.

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Conflict of interest statement

Funding Support and Author Disclosures The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). Dr Shah was supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008. Dr Chandra was supported by NIH grant 5T32HL094301-08. Dr Shah has received research support from Novartis and Philips Ultrasound through the Brigham and Women’s Hospital; and has received consulting fees from Philips Ultrasound and Edwards Lifesciences. Dr Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Novartis, Sanofi Pasteur, and Theracos; and has consulted for Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GSK, Ironwood, Merck, MyoKardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Dinaqor, and Tremeau. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1. Cardiac structural and functional abnormalities in participants without heart failure
Prevalence of cardiac structural abnormalities and left ventricular systolic and diastolic abnormalities among participants free of prevalent heart failure in subgroups defined according to gender and race.
Figure 2
Figure 2. Association of race-gender groups with incident HF in late-life
(A) Incident heart failure (HF) overall. (B) Incident heart failure with reduced ejection fraction (HFrEF). (C) Incident heart failure with pre-served ejection fraction (HFpEF). Median follow-up time for the end point was 5.5 years (interquartile interval: 5.0–6.0 years). Event rate is expressed per 1,000 person-years and is adjusted for age. HRs are adjusted for age.
Figure 2
Figure 2. Association of race-gender groups with incident HF in late-life
(A) Incident heart failure (HF) overall. (B) Incident heart failure with reduced ejection fraction (HFrEF). (C) Incident heart failure with pre-served ejection fraction (HFpEF). Median follow-up time for the end point was 5.5 years (interquartile interval: 5.0–6.0 years). Event rate is expressed per 1,000 person-years and is adjusted for age. HRs are adjusted for age.
Figure 2
Figure 2. Association of race-gender groups with incident HF in late-life
(A) Incident heart failure (HF) overall. (B) Incident heart failure with reduced ejection fraction (HFrEF). (C) Incident heart failure with pre-served ejection fraction (HFpEF). Median follow-up time for the end point was 5.5 years (interquartile interval: 5.0–6.0 years). Event rate is expressed per 1,000 person-years and is adjusted for age. HRs are adjusted for age.
Figure 3
Figure 3. Race and gender’s associations with incident HF adjusting for biomarkers
HR (95% CI) for incident HF hospitalization associated with Black race (A) and male gender (B) among participants free of prevalent HF. Risk factors included age, hypertension, body mass index, diabetes, history of coronary heart disease, atrial fibrillation, and education level. NT-proBNP ¼ N-terminal pro–B-type natriuretic peptide; hs-TnT ¼ high-sensitivity troponin T; RF ¼ risk factor; other abbreviations as in Figure 2.
Figure 3
Figure 3. Race and gender’s associations with incident HF adjusting for biomarkers
HR (95% CI) for incident HF hospitalization associated with Black race (A) and male gender (B) among participants free of prevalent HF. Risk factors included age, hypertension, body mass index, diabetes, history of coronary heart disease, atrial fibrillation, and education level. NT-proBNP ¼ N-terminal pro–B-type natriuretic peptide; hs-TnT ¼ high-sensitivity troponin T; RF ¼ risk factor; other abbreviations as in Figure 2.
Central Illustration.
Central Illustration.. Association of Black race and male gender with incident HF
Hazard ratio for incident HF hospitalization associated with Black race (Panel A) and male gender (Panel B) among participants free of prevalent HF. Multivariable models are adjusted for age, study center, hypertension, body mass index, diabetes, history of coronary heart disease, atrial fibrillation, and education level.
Central Illustration.
Central Illustration.. Association of Black race and male gender with incident HF
Hazard ratio for incident HF hospitalization associated with Black race (Panel A) and male gender (Panel B) among participants free of prevalent HF. Multivariable models are adjusted for age, study center, hypertension, body mass index, diabetes, history of coronary heart disease, atrial fibrillation, and education level.
See this image and copyright information in PMC

Comment in

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