Lifetime Risk for Heart Failure Among White and Black Americans
Key result
Lifetime heart failure risk reaches up to ~45%, driven lower in Black men by competing mortality.
- n=39,578
Why the study?
Prior lifetime risk estimates for heart failure were derived predominantly from white cohorts, with limited comparisons of lifetime risk between blacks and whites.
Key Points
- To estimate and compare the lifetime risk for developing heart failure through age 95 years by sex and race.
- Analyzed pooled data from 39,578 participants (33,652 [85%] white; 5,926 [15%] black) followed for 716,976 person-years across the CHA, ARIC, and CHS cohorts.
- Estimated cumulative lifetime risks for incident heart failure up to age 95 years, treating death free of heart failure as a competing risk event.
- Across cohorts, 5,983 participants developed heart failure; at age 45, lifetime risks through age 95 in CHA and CHS were 30-42% in white men, 20-29% in black men, 32-39% in white women, and 24-46% in black women.
- In the CHA cohort at age 45, remaining lifetime risk was 30.2% (95% CI, 28.9 to 31.5) for white men, 20.1% (95% CI, 15.8 to 24.4) for black men, 32.3% (95% CI, 30.8 to 33.8) for white women, and 23.7% (95% CI, 17.8 to 29.8) for black women.
- Higher blood pressure and body mass index substantially increased heart failure risk across all race and sex groups, while higher non-cardiovascular competing mortality among black men limited their observed lifetime risk.
Study Design
Type
Cohort (n=39,578)
Multicenter
Yes
Structured PICO
P
Population
39,578 black and white American adults free of heart failure at baseline, followed for 716,976 person-years to estimate lifetime risk of developing heart failure.
O
Outcome
Incident heart failure (overt HF) with death free of HF as a competing event, estimated up to age 95.hard clinical
Limitations
- Cohorts defined HF differently, which likely affected lifetime risk estimates across different populations.
- Different cohorts had different entry criteria and different index ages ranging from <45 to ≥65.
- Analysis of ARIC was limited to public-release dataset, which likely explains lower estimates compared with the internal dataset.
- Data were collected from participants in different age ranges at different time points, which could lead to birth cohort effects.
- CHA HF events were collected through Medicare discharge data, meaning HF events that occurred before age 65 years would have been missed.
- Cohorts defined HF differently (e.g., hospital discharge coding vs. adjudication).
- Different entry criteria and index ages across cohorts.
- ARIC analysis limited to public-release dataset with shorter follow-up.
- Data collected at different time points could lead to birth cohort effects.
- CHA HF events collected through Medicare discharge data, missing events before age 65.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is a bad news scenario for both race groups. With lifetime risks this high, heart failure prevention is paramount for all Americans.”
“There are things we can do to help prevent heart failure risks, but it requires a concerted effort, not just on the individual level but in our communities. Not smoking, staying physically active, maintaining a healthy weight over a long period of time, maintaining a healthy blood pressure and preventing heart attacks are all things Americans can to keep their hearts healthy as they age.”
Implication
Lifetime risk for heart failure is high (20-45%) across both black and white populations, with similar risks for women of both races but slightly lower lifetime risk for black men due to higher competing non-cardiovascular mortality.
Abstract
Objective To estimate lifetime risk for HF by sex and race. Background Prior estimates of lifetime risk for developing heart failure (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 NHLBI-sponsored cohorts, we estimated lifetime risks for developing HF to age 95, with death free of HF as the competing event, among participants in Chicago Heart Association Detection Project in Industry (CHA), Atherosclerosis Risk in Communities (ARIC), and Cardiovascular Health Study (CHS) 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 30-42% in white men, 20-29% in black men, 32-39% in white women, and 24-46% 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 BP and BMI 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.
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Cite This Study
Huffman et al. (2013) conducted a cohort in Heart Failure (n=39,578). Black race vs. White race was evaluated on Lifetime risk for developing heart failure to age 95. Lifetime risks for heart failure are high (20-45%) and appear similar for black and white women, but are somewhat lower for black men compared with white men due to competing risks of death.