Population attributable risk of traditional, under-recognised and female-specific factors for heart failure in women

Background Heart failure (HF) imposes a major health burden on women. While traditional (well-established) risk factors are well studied, less attention has been given to psychosocial, environmental and female-specific reproductive risk factors. This study quantifies the contribution of these risk domains to incident HF in women. Methods We included 233 125 women from the UK Biobank with a median follow-up of 13.7 years. 22 risk factors were grouped as well-established (eg, hypertension), under-recognised (eg, depression, socioeconomic deprivation) or female-specific (eg, early age at menopause, parity). Cox regression models and population attributable fractions (PAFs) were used to estimate HF risk and burden. Analyses were stratified by age and obesity. Results A total of 6077 women developed HF. The overall PAF for all risk factors was 66.0%. Hypertension had the largest individual contribution (PAF 25.3%). Well-established, under-recognised and female-specific risk factors accounted for 46.0%, 25.5% and 15.5% of HF cases, respectively. Chronic inflammatory diseases, early age at menopause and early age at first birth were key reproductive drivers. Age-stratified analyses showed the highest HF burden in women aged 55–59 years (PAF 70.0%). Conclusion A combination of modifiable, psychosocial, environmental and reproductive risk factors accounts for two-thirds of HF cases in women. Tailored, life course–oriented prevention strategies are essential to reduce this burden.