Age-Related Race- and Sex-Based Differences in Risk for Heart Failure

Person with chest pain
3d rendered illustration of a man with chest pain.
Researchers investigated the race- and sex-based differences in heart failure risk factors and cardiac function in older patients.

Among older patients free of existing heart failure (HF), White men, Black men, and Black women are at higher risk for heart failure with reduced ejection fraction (HFrEF) than White women, according to research published in the Journal of the American College of Cardiology.

This prospective epidemiologic cohort study included 5149 HF-free participants with a mean age of 75±5 years; 59% were women; and 20% were Black patients from ARIC (Atherosclerosis Risk In Communities), an ongoing study in 4 US centers. Since inception of the study (1987-1989), participants were followed up every 5 years for hospitalizations for coronary heart disease (CHD) events, and only participants who received an echocardiogram at the fifth visit (2011-2013) were included in this current study. Participants were further followed up for a median of 5.5 years (IQR, 5.0-6.0) after visit 5 for incidence of HF or death.

Researchers found that among older participants (66-90 years of age) men exhibited worse measures of left ventricular (LV) systolic function and were at higher risk for incident HFrEF compared with women, particularly among Black participants. Black race was associated with greater LV concentric remodeling and worse LV systolic function in both genders, as well as an increased risk for HFrEF among men. However, differences in diastolic measures were not observed across race and sex, and the risk for heart failure with preserved ejection fraction for all groups was similar.

The investigators noted the following limitations in their study: Only 62% of ARIC participants still alive in 2011 chose to attend visit 5, which may have introduced an attendance bias; a study design that designated LVEF less than 50% as HFrEF; the majority of Black participants were from 1 study center; and the analysis was unable to address the mechanisms responsible for sex- and race-based differences.

 “The persistence of these differences in HF risk, and HFrEF risk in particular, according to race/[sex] group in analyses adjusting for traditional cardiovascular risk factors suggest important residual risk related to race and gender that persists into late life,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Chandra A, Skali H, Claggett B, et al. Race- and gender-based differences in cardiac structure and function and risk of heart failure. J Am Coll Cardiol. Published online January 24, 2022. doi:10.1016/j.jacc.2021.11.024