Measurement of coronary artery calcium (CAC) may stratify risk of heart failure with preserved ejection fraction (HFpEF) beyond traditional coronary artery disease (CAD) risk factors for women, a recent study found. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), the cohort examined the association of CAC and the risk of HFpEF in both men and women. Researchers measured CAC at baseline in all 6,809 participants (mean age 62 years, 53% female, 38% white, 12% black) with incident HFpEF defined as HF hospitalization with left ventricular ejection fraction ≥50%. They found:

• 127 incident HFpEF cases (1.8%) were identified over a median follow-up of 11.2 years.
• In adjusted analysis, CAC >300 was associated with increased risk of HFpEF (HR, 1.68); however, this was significant only in women (2.82 vs 0.91 for men).
• CAC modeled as a continuous variable was strongly predictive in women but not men.