Gender aspects on heart failure incidence and mortality in a middle-aged, urban, community-based population sample: the Malmö preventive project

There is little epidemiological data on heart failure (HF) in the younger age groups dominating clinical HF trials. We assessed gender-specific long-term HF incidence and mortality in an urban community-based sample of middle-aged subjects. Between 1974 and 1992, 33,342 HF-free subjects (10,900 [32.7%] women, mean age 45.7 ± 7.4 years) were included in the Malmö Preventive Project, on average 21.7 ± 4.3 years before study end. Patients hospitalised for or dying of HF were categorised as HF patients, and 120 (1.1%) women versus 644 (2.9%) men experienced HF: 6.0 vs. 12.3 cases per 10,000 person years; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.50–0.74, P < 0.0001. Among all subjects, women compared with men had lower all-cause (49.3 vs. 84.0 cases per 10,000 person years; HR 0.68, 95% CI 0.64–0.73, P < 0.0001) and HF-related (2.6 vs. 7.4 cases per 10,000 person years; HR 0.50, 95% CI 0.37–0.67, P < 0.0001) mortality risk. Female and male HF patients had similar age-adjusted mortality risk: 1,314 vs. 1,602 cases per 10,000 patient years; HR 0.78, 95% CI 0.58–1.07, P = 0.12. Among HF patients, 55.3% of deaths in women and 40.6% in men were non-cardiovascular, and only 7.9% deaths were due to HF. In conclusion: In a middle-aged, urban, community-based sample, women had lower risk of HF, all-cause death and HF-related death over two decades of follow-up. Female and male HF patients had similar mortality risk after the diagnosis of HF. In these comparatively young HF patients, few deaths were due to HF and more than 4 out of 10 deaths were non -cardiovascular.