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

Background: Although heart failure (HF) risk and cardiac structure/function have been reported to differ by race and gender, limited data exist in late-life when HF risk is highest. Objectives: To study race/gender-based differences in HF risk factors, cardiac structure/function, and incident HF in late-life. Methods: We studied 5,149 HF-free participants in the Atherosclerosis Risk in Communities (ARIC) study, a prospective epidemiologic cohort study, who attended Visit 5 (2011–2013) and underwent echocardiography. Participants were subsequently followed for a median 5.5 years for incident HF/death. Results: Mean age was 75±5 years, 59% were women, and 20% were Black race. Male gender and Black race were associated with lower mean LVEF. Black race was also associated with greater LV 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 HFrEF in Black compared to White participants (HF: HR 2.36 [95% CI 1.37–4.08] vs. 1.16 [0.89–1.51], interaction P = 0.016; HFrEF: 3.70 [1.72–7.95] vs. 1.55 [1.01–2.37] respectively, interaction P = 0.039). Black race was associated with higher incidence of HF overall and HFrEF in men only (HF: 1.65 [1.07–2.53] vs. 0.77 [0.49–1.17]; HFrEF: 2.55 [1.46–4.44] vs. 0.91 [0.46–1.83]). No race/gender-based differences were observed in risk of incident HFpEF. Conclusions: Among older persons free of HF, men and Black participants demonstrate worse systolic performance and are at heightened risk for HFrEF, while the risk of HFpEF is similar across gender and race groups.