Indoor Radon and Incident Heart Failure Among Postmenopausal Women
17 affiliations
- 1Department of Statistics and Operations Research, University of North Carolina, Chapel Hill
- 2Department of Biostatistics, University at Buffalo, State University of New York
- 3Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- 4Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- 5Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill
- 6Department of Family Medicine, University of California San Diego, La Jolla
- 7Department of Family Medicine, Warren Alpert Medical School and Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
- 8Department of Medicine IV and Karl Landsteiner Institute for Cardiovascular Research, Clinic Hietzing, Medical University of Vienna, Vienna, Austria
- 9Klinik für Innere Medizin III and Homburg Institute of CardioRenalMetabolic Medicine (HOMICAREM), Saarland University, Homburg, Saarland, Germany
- 10Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
- 11Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo
- 12Division of Cardiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- 13Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
- 14Department of Epidemiology, University of Washington, Seattle
- 15Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks
- 16Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
- 17Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
Abstract
Importance: Evidence has shown an association of radon exposure with heart failure risk factors, but whether there is an association with heart failure remains unclear.
Objective: To assess whether indoor radon concentrations are associated with incident heart failure among US postmenopausal women.
Design, Setting, and Participants: This prospective cohort study used data from the Women’s Health Initiative (WHI) observational study and clinical trials. Participants were postmenopausal women from 40 US clinical centers who were aged 50 to 79 years and did not have self-reported heart failure at enrollment or randomization (September 1993 to December 1998) but had physician adjudication of heart failure during follow-up through February 17, 2024.
Exposure: Geocoded participant address–based assignment of county-level, US Environmental Protection Agency–categorized indoor radon concentration (<2, 2-4, or >4 picocuries [pCi]/L).
Main Outcome and Measure: Incident hospitalization for acute decompensated heart failure was ascertained through physician adjudication of medical records. Hazard ratios (HRs) for heart failure by indoor radon concentration were estimated with Cox proportional hazards regression models.
Results: Among 43 188 postmenopausal women (mean [SD] age, 63 [7] years), 36% were exposed to a radon concentration less than 2 pCi/L; 41%, to a concentration of 2 to 4 pCi/L; and 23%, to a concentration of more than 4 pCi/L. Over a mean (SD) follow-up of 16.2 (8.4) years, 3446 incident heart failure events occurred. The fully adjusted HR for heart failure was 1.19 (95% CI, 1.07-1.33) at more than 4 pCi/L vs less than 2 pCi/L, changing little in sensitivity analyses. The HR was higher for heart failure with reduced ejection fraction (1.24; 95% CI, 1.04-1.49) and heart failure mortality (1.37; 95% CI, 1.12-1.69) at radon concentrations more than 4 pCi/L vs less than 2 pCi/L, but these HRs were not different from the null at concentrations of 2 to 4 pCi/L vs less than 2 pCi/L. The HR at concentrations greater than 4 pCi/L approximated that of a 16–mm Hg increase in systolic blood pressure or an increase of 4.8 in body mass index (calculated as weight in kilograms divided by height in meters squared).
Conclusions and Relevance: In this cohort study of US postmenopausal women, higher indoor radon concentrations were associated with an increased risk of incident heart failure, suggesting that radon may be a modifiable environmental determinant of heart failure.
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BibTeX
@article{chen2026indoor,
title = {{Indoor Radon and Incident Heart Failure Among Postmenopausal Women}},
author = {Shu Chen and Cuiran Shi and Jason M. Collins and Ayesha K. Ekanayaka and Carson Mowrer and James D. Stewart and David Y. Huang and Matthew A. Allison and Charles B. Eaton and Bernhard Haring and Michael J. LaMonte and Matthew S. Nudy and Alexander P. Reiner and Gary G. Schwartz and David Z. Shou and Lesley F. Tinker and Mark R. Williamson and Richard L. Smith and Eric A. Whitsel},
journal = {JAMA Network Open},
year = {2026},
month = nov,
doi = {10.1001/jamanetworkopen.2026.42391},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856258},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Indoor Radon and Incident Heart Failure Among Postmenopausal Women
AU - Shu Chen
AU - Cuiran Shi
AU - Jason M. Collins
AU - Ayesha K. Ekanayaka
AU - Carson Mowrer
AU - James D. Stewart
AU - David Y. Huang
AU - Matthew A. Allison
AU - Charles B. Eaton
AU - Bernhard Haring
AU - Michael J. LaMonte
AU - Matthew S. Nudy
AU - Alexander P. Reiner
AU - Gary G. Schwartz
AU - David Z. Shou
AU - Lesley F. Tinker
AU - Mark R. Williamson
AU - Richard L. Smith
AU - Eric A. Whitsel
PY - 2026
DA - 2026/11/05
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.42391
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856258
AB - Importance: Evidence has shown an association of radon exposure with heart failure risk factors, but whether there is an association with heart failure remains unclear. Objective: To assess whether indoor radon concentrations are associated with incident heart failure among US postmenopausal women. Design, Setting, and Participants: This prospective cohort study used data from the Women’s Health Initiative (WHI) observational study and clinical trials. Participants were postmenopausal women from 40 US clinical centers who were aged 50 to 79 years and did not have self-reported heart failure at enrollment or randomization (September 1993 to December 1998) but had physician adjudication of heart failure during follow-up through February 17, 2024. Exposure: Geocoded participant address–based assignment of county-level, US Environmental Protection Agency–categorized indoor radon concentration (<2, 2-4, or >4 picocuries [pCi]/L). Main Outcome and Measure: Incident hospitalization for acute decompensated heart failure was ascertained through physician adjudication of medical records. Hazard ratios (HRs) for heart failure by indoor radon concentration were estimated with Cox proportional hazards regression models. Results: Among 43 188 postmenopausal women (mean [SD] age, 63 [7] years), 36% were exposed to a radon concentration less than 2 pCi/L; 41%, to a concentration of 2 to 4 pCi/L; and 23%, to a concentration of more than 4 pCi/L. Over a mean (SD) follow-up of 16.2 (8.4) years, 3446 incident heart failure events occurred. The fully adjusted HR for heart failure was 1.19 (95% CI, 1.07-1.33) at more than 4 pCi/L vs less than 2 pCi/L, changing little in sensitivity analyses. The HR was higher for heart failure with reduced ejection fraction (1.24; 95% CI, 1.04-1.49) and heart failure mortality (1.37; 95% CI, 1.12-1.69) at radon concentrations more than 4 pCi/L vs less than 2 pCi/L, but these HRs were not different from the null at concentrations of 2 to 4 pCi/L vs less than 2 pCi/L. The HR at concentrations greater than 4 pCi/L approximated that of a 16–mm Hg increase in systolic blood pressure or an increase of 4.8 in body mass index (calculated as weight in kilograms divided by height in meters squared). Conclusions and Relevance: In this cohort study of US postmenopausal women, higher indoor radon concentrations were associated with an increased risk of incident heart failure, suggesting that radon may be a modifiable environmental determinant of heart failure.
SN - 2574-3805
ER -