Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative

Khadijah Breathett, Iris Leng, Randi E. Foraker, William T. Abraham, Laura Coker, Keith E. Whitfield, Sally Shumaker, Jo Ann E. Manson, Charles B. Eaton, Barbara V. Howard, Nkechinyere Ijioma, Crystal W. Cene, Lisa W. Martin, Karen Johnson, Liviu Klein

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS: In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11996), white (n=18479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS: Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups.

Original languageEnglish (US)
Article numbere004642
JournalCirculation: Heart Failure
Volume11
Issue number5
DOIs
StatePublished - May 1 2018

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Women's Health
Ethnic Groups
Heart Failure
Survival
Hispanic Americans
African Americans
Survival Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative. / Breathett, Khadijah; Leng, Iris; Foraker, Randi E.; Abraham, William T.; Coker, Laura; Whitfield, Keith E.; Shumaker, Sally; Manson, Jo Ann E.; Eaton, Charles B.; Howard, Barbara V.; Ijioma, Nkechinyere; Cene, Crystal W.; Martin, Lisa W.; Johnson, Karen; Klein, Liviu.

In: Circulation: Heart Failure, Vol. 11, No. 5, e004642, 01.05.2018.

Research output: Contribution to journalArticle

Breathett, K, Leng, I, Foraker, RE, Abraham, WT, Coker, L, Whitfield, KE, Shumaker, S, Manson, JAE, Eaton, CB, Howard, BV, Ijioma, N, Cene, CW, Martin, LW, Johnson, K & Klein, L 2018, 'Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative', Circulation: Heart Failure, vol. 11, no. 5, e004642. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004642
Breathett, Khadijah ; Leng, Iris ; Foraker, Randi E. ; Abraham, William T. ; Coker, Laura ; Whitfield, Keith E. ; Shumaker, Sally ; Manson, Jo Ann E. ; Eaton, Charles B. ; Howard, Barbara V. ; Ijioma, Nkechinyere ; Cene, Crystal W. ; Martin, Lisa W. ; Johnson, Karen ; Klein, Liviu. / Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative. In: Circulation: Heart Failure. 2018 ; Vol. 11, No. 5.
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abstract = "BACKGROUND: The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS: In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11996), white (n=18479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95{\%} confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS: Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups.",
author = "Khadijah Breathett and Iris Leng and Foraker, {Randi E.} and Abraham, {William T.} and Laura Coker and Whitfield, {Keith E.} and Sally Shumaker and Manson, {Jo Ann E.} and Eaton, {Charles B.} and Howard, {Barbara V.} and Nkechinyere Ijioma and Cene, {Crystal W.} and Martin, {Lisa W.} and Karen Johnson and Liviu Klein",
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T1 - Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative

AU - Breathett, Khadijah

AU - Leng, Iris

AU - Foraker, Randi E.

AU - Abraham, William T.

AU - Coker, Laura

AU - Whitfield, Keith E.

AU - Shumaker, Sally

AU - Manson, Jo Ann E.

AU - Eaton, Charles B.

AU - Howard, Barbara V.

AU - Ijioma, Nkechinyere

AU - Cene, Crystal W.

AU - Martin, Lisa W.

AU - Johnson, Karen

AU - Klein, Liviu

PY - 2018/5/1

Y1 - 2018/5/1

N2 - BACKGROUND: The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS: In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11996), white (n=18479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS: Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups.

AB - BACKGROUND: The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS: In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11996), white (n=18479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS: Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups.

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