Risk for Heart Failure Among White and Black Americans
Risk for Heart Failure Among White and Black Americans
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.
Heart failure (HF) is a growing public health crisis, with increasing morbidity, mortality, and costs. Declines in HF incidence over previous decades have flattened, with increases in HF prevalence due to lower case-fatality rates. Indeed, HF prevalence increased by as much as 30% in Medicare beneficiaries from 1994 to 2003. This increased prevalence of HF, however, may not be solely a result of patients surviving myocardial infarctions (MIs) in the era of revascularization and aggressive medical therapy, but more likely is associated with rising rates of obesity, hypertension, and diabetes, as well as improved survival among those with HF.
Lifetime risk for developing HF has been estimated to range from 20% to 33%, respectively, in the Framingham and Rotterdam studies, 2 cohorts of almost exclusively white individuals of European ancestry. However, these studies used different criteria to define HF, which may partially account for the differences in lifetime risk.
Whereas short-term risks for HF incidence appear to be significantly higher for blacks than whites in the United States, only limited comparisons of lifetime risk for HF have been made between white and black individuals. Lifetime risk estimates account for the risk of incident HF as well as for the risk of death from competing causes, and overall and noncardiovascular mortality risk is known to be higher among blacks than whites (especially in men). Therefore, it is unknown whether lifetime risks for HF differ between blacks and whites. Further, knowledge of absolute lifetime risk estimates may be useful for policymakers, patients, and physicians alike to estimate the current and future population burden of disease, as well as to estimate individual risks. A similar strategy used for breast cancer risk estimation has been cited as a contributor to increased breast cancer screening in the 1990s.
We sought to define and compare the lifetime risks for HF by sex and race at selected ages in several diverse population samples by examining the results of prospective, observational studies with data on HF endpoints, namely CHA (the Chicago Heart Association Detection Project in Industry), ARIC (Atherosclerosis Risk In Communities Study), and CHS (Cardiovascular Health Study).
Abstract and Introduction
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.
Introduction
Heart failure (HF) is a growing public health crisis, with increasing morbidity, mortality, and costs. Declines in HF incidence over previous decades have flattened, with increases in HF prevalence due to lower case-fatality rates. Indeed, HF prevalence increased by as much as 30% in Medicare beneficiaries from 1994 to 2003. This increased prevalence of HF, however, may not be solely a result of patients surviving myocardial infarctions (MIs) in the era of revascularization and aggressive medical therapy, but more likely is associated with rising rates of obesity, hypertension, and diabetes, as well as improved survival among those with HF.
Lifetime risk for developing HF has been estimated to range from 20% to 33%, respectively, in the Framingham and Rotterdam studies, 2 cohorts of almost exclusively white individuals of European ancestry. However, these studies used different criteria to define HF, which may partially account for the differences in lifetime risk.
Whereas short-term risks for HF incidence appear to be significantly higher for blacks than whites in the United States, only limited comparisons of lifetime risk for HF have been made between white and black individuals. Lifetime risk estimates account for the risk of incident HF as well as for the risk of death from competing causes, and overall and noncardiovascular mortality risk is known to be higher among blacks than whites (especially in men). Therefore, it is unknown whether lifetime risks for HF differ between blacks and whites. Further, knowledge of absolute lifetime risk estimates may be useful for policymakers, patients, and physicians alike to estimate the current and future population burden of disease, as well as to estimate individual risks. A similar strategy used for breast cancer risk estimation has been cited as a contributor to increased breast cancer screening in the 1990s.
We sought to define and compare the lifetime risks for HF by sex and race at selected ages in several diverse population samples by examining the results of prospective, observational studies with data on HF endpoints, namely CHA (the Chicago Heart Association Detection Project in Industry), ARIC (Atherosclerosis Risk In Communities Study), and CHS (Cardiovascular Health Study).
