Racial and Ethnic Differences in Incident Hospitalized Heart Failure in Postmenopausal Women The Women's Health Initiative

Background —The differences in the incidence of heart failure (HF) by race/ethnicity as well as the potential mechanisms for these differences are largely unexplored in women. Methods and Results —155,335 post menopausal women free of self-reported HF enrolled from 1993-1998 at 40 clinical centers throughout the United States as part of the Women9s Health Initiative and were followed until 2005, for an average of 7.7 years for incident hospitalized heart failure. Incident rates, hazard9s ratios and 95% CI were determined using Cox-proportional hazard9s model comparing racial/ethnic groups and population attributable risk percentages were calculated for each racial/ethnic group. African Americans had the highest age-adjusted incidence of HF (405/100,000 person-years) followed by whites (283) Hispanics (191) and Asian/Pacific Islanders (102). The excess risk in African Americans compared to whites (age-adjusted HR= 1.47) was significantly attenuated by adjustment for household income (HR=0.99) and diabetes mellitus (HR=0.92) but the lower risk in Hispanics (age-adjusted HR=0.76) and Asian/Pacific Islanders (age-adjusted HR=0.40) remained despite adjustment for traditional risk factors, socioeconomic status, lifestyle and access to care variables. The effect of adjustment for interim CHD on non-white versus white hazard ratios for heart failure differed by race/ethnic group. Conclusions —Asian/Pacific Islander and Hispanic women have a lower incidence of heart failure while African American women have higher rates of heart failure compared to white women. The excess risk of incident heart failure in African American women is largely explained by adjustment for lower household incomes and diabetes in African American women while the lower rates of heart failure in Asian/Pacific Islanders and Hispanics are largely unexplained by the risk factors measured in this study. Clinical Trial Registration Information —http://www.clinicaltrials.gov; Unique Identifier: NCT00000611