Background:
The past two decades have witnessed divergent trends in the prevalence of major cardiovascular disease risk factors and advances in medical therapy for coronary disease. Over this time period (1990-2009), we hypothesized that the incidence of heart failure with preserved ejection fraction (HFPEF) may have decreased with improved blood pressure control, whereas the incidence of heart failure with reduced ejection fraction (HFREF) may have increased due to improved treatment of coronary disease with myocardial salvage.
Methods:
We studied Framingham Heart Study Original and Offspring Cohort participants at least 40 years of age and free of HF (n=6648, 56% women, 21285 five-year epochs, 769 HF, 97829 person-years). We estimated age- and sex-adjusted rates of HF, HFPEF, and HFREF (cumulative incidence at 5 years) for 5-year time windows between 1990 and 2009 and for 10-year intervals, 1990-1999 and 2000-2009. We used proportional hazards models to estimate cumulative incidence and test time trends in hazards ratios, for the overall sample and for each sex separately.
Results:
HF incidence varied modestly across the time windows but differences were not statistically significant overall, in men, or in women (
TABLE
). Across the two decades, there was a 40% increase in the incidence of HFPEF (p=0.003), but a 20% decrease in the incidence of HFREF (p<0.0001). The incidence of HFPEF between decades did not change significantly in men but increased 56% in women (p=0.014). Between decades, the incidence of HFREF declined by 13% in men and by 29% in women (p=0.01 and 0.003, respectively).
Conclusions:
Whereas the overall incidence of HF has not changed significantly in the past two decades, the incidence of HFPEF has risen and that of HFREF has declined reciprocally, opposite to what we hypothesized. Future investigation into the potential factors underlying these intriguing trends is warranted.
Exercise Systolic Blood Pressure at Moderate Workload Is Linearly Associated With Coronary Disease Risk in Healthy Men
