Abstract 16059: Racial and Ethnic Differences in Preserved Ejection Fraction and Reduced Ejection Fraction Incident Heart Failure in a Multiracial Cohort of Post-Menopausal Women

Abstract

Introduction: We compared the incidence of Heart Failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) in African-Americans (AA), Hispanic (H) and Caucasian (C) women in the Women Health Initiative (WHI) and evaluated risk factors to explain differences in rates of incident hospitalized HFpEF and HFrEF . METHODS: A multi-racial cohort of 42,272 post-menopausal women that oversampled for H and AA were followed for mean of 11.3 years and evaluated for incident HFpEF or HFrEF. Risk factors for incident HFpEF and HFrEF were tested using Cox proportional hazards regression models for AA, H and C with appropriate sample weighting. RESULTS: There were a total of 1497 incident cases of HF, of which, 632 were HFpEF, 545 HFrEF, and 320 with an unknown ejection fraction. Age, SES, hypertension, diabetes, tobacco use, CHD were risk factors for both HFpEF and HFrEF whereas obesity, number of co-morbid conditions, and anemia were risk factors for HFpEF only (p <0.001). After adjusting for age, and compared to C, HFpEF and HFrEF were more common in AA (HR 1.12 and 1.43) and less common in H (HR 0.60 and 0.70). For HFpEF, the differences between AA and C were explained by income as the HR is no longer significant after adjusting for income (HR = 0.99; CI 0.73 - 1.33) and clinical risk factors such as hypertension, diabetes, and obesity (HR 0.74; CI 0.53 - 1.02). For HFrEF, the differences between AA and C were only partially explained by income disparities (HR 1.17, CI 0.85 - 1.60) while hypertension, diabetes, dyslipidemia and coronary heart disease played a more important role (HR 0.75; CI 0.52 - 1.07). For Hispanics, the inverse association for HFpEF and HFrEF were accentuated after accounting for income disparities (HR=0.51 and 0.47), and similarly clinical risk factors such as hypertension, diabetes, obesity and dyslipidemia (HR=0.46 and 0.45). CONCLUSION: In post-menopausal women, incident HFpEF and HFrEF are more common in AA than C, while the incidence is lower in H women. Differences in clinical risk factors and income explain the differences in AA compare to C, but not the inverse associations in H.