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Fewer heart failure risk factors by midlife cuts long-term risk

Avoiding hypertension, obesity and diabetes has long-term preventive benefits

Louise Prime

Tuesday, 29 November 2016

Men and women who have avoided risk factors for heart failure until they reach middle age have a considerably lower risk of going on to develop heart failure compared with people who already have hypertension, obesity or diabetes by that point, researchers have reported* today in JACC: Heart Failure. They said their results underline the importance of public health efforts to reduce the burden of heart failure at population level.

The study authors conducted a pooled, individual-level analysis of US-wide data on three risk factors – hypertension, obesity and diabetes – and on the incidence of heart failure. They reported that by the age of 45 years, 53.2% of people had neither hypertension, obesity nor diabetes; and by the age of 55 years the proportion with none of the three risk factors had fallen to 43.7%. They found that 1,677 cases of incident heart failure were identified after the age of 45 years, during 516,537 person-years’ follow up; and 2,976 cases of incident heart failure were identified at the age of 55 years, during 502,252 person-years’ follow up.

Overall, men and women with no risk factors at the age of 45, compared with those with all three, had between 73% and 85% lower risks of incident heart failure. People without hypertension, obesity, or diabetes by the age of 45 years lived an additional 3-15 years free of heart failure, on average, than those with one, two or three of these risk factors.

Men who reached 45 years with none of the three risk factors lived an extra 10.6 years free of heart failure; and women an extra 14.9 years. White study participants lived an extra 12.4 years and black people an extra 12.9 years if they reached 45 years old with none of these risk factors. Similar trends were seen among people who reached 55 years with none of hypertension, obesity or diabetes.

Diabetes in particular was associated with reduced heart failure-free survival: people without diabetes at 45 and 55 years old lived for a mean of 8.6 years and 10.6 years longer, respectively, without heart failure.

The authors said: “This study adds to the understanding of how individual and aggregate risk factor levels, specifically in middle age, affect incident heart failure risk over the remaining lifespan.”

They concluded: “Prevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure.”


* Ahmad FS, Ning H, Rich JD, et al. Hypertension, obesity, diabetes, and heart failure-free survival: the cardiovascular disease lifetime risk pooling project. JCHF 2016; 4(12) :911-919. doi:10.1016/j.jchf.2016.08.001.

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