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Original research
Sex differences in the association of risk factors for heart failure incidence and mortality
  1. Anne Sillars1,
  2. Frederick K Ho2,
  3. Gill P Pell2,
  4. Jason M R Gill1,
  5. Naveed Sattar1,
  6. Stuart Gray1,
  7. Carlos Celis-Morales1
  1. 1 British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2 Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Anne Sillars, ICAMS, University of Glasgow, Glasgow, UK; anne.sillars{at}


Background There are known risk factors associated with the development of heart failure (HF), but it is not fully understood whether these differ by sex.

Objectives To investigate sex differences in risk factors for HF incidence and mortality.

Methods 468 941 participants (55.9% women, age range 37–73 years) were included. Established CVD risk factors (hypertension, hypercholesterolaemia, diabetes type 1 and 2, adiposity, smoking, physical activity and poor diet) and novel risk factors (grip strength, fitness, TV viewing and sleep duration) were the exposures of interest. HF incidence and mortality were the outcomes.

Results Over a mean follow-up of 9.0 years, 1812 participants developed HF and 763 died due to HF. Women with type 1 diabetes (T1DM), type 2 diabetes (T2DM), hypertension, hypercholesterolaemia, low levels of physical activity and fitness, low strength, high levels of TV viewing, sleep duration <7 hours/day, smokers; those who were underweight and who were obese, had high body surface area and those who drink >14 units of alcohol were at higher risk of HF incidence. However, in women T2DM, hypercholesterolaemia, >3 hours/day of TV and sleep <7 hours/day, low level of physical activity and high level of TV viewing were more strongly associated with HF incidence compared with men.

Conclusion Several modifiable risk factors (in particular diabetes) appear more strongly associated with HF in women compared with men. The relevance of these findings to HF characteristics and future outcomes needs to be established.

  • heart failure
  • obesity
  • epidemiology

Statistics from


  • AS and FKH are joint first authors.

  • SG and CC-M are joint first authors.

  • AS and FKH contributed equally.

  • SG and CC-M contributed equally.

  • Contributors AS, FH, SG and CCM contributed to the study conception, study design, analysis and drafting. All authors contributed to interpretation of data and critical revision of the content of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The UK Biobank study was approved by the North West Multicentre Research Ethics Committee (REC reference: 11/NW/03820).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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