Avoiding HF Risk Factors Before Midlife May Lower Risk

Preventing the onset of hypertension, obesity and diabetes by the age of 45 to 55 years may lower the risk for heart failure (HF) through the remainder of life by up to 86 percent, according to research published Nov. 28 in JACC: Heart Failure.

Faraz S. Ahmad, MD, and colleagues conducted a pooled, individual-level analysis sampling from communities across the U.S. They found that at ages 45 and 55 years, respectively, 53.2 percent and 43.7 percent of participants were free of hypertension, obesity and diabetes. After the index age of 45 years, during 516,537 person-years of follow-up, 1,677 cases of incident HF were identified. At an index age of 55 years, during 502,252 person-years of follow-up, 2,976 cases of incident HF were identified.

Results showed at index age 45 and 55 years, participants without hypertension, obesity and diabetes had a substantially lower risk for HF. Diabetes was found to have a particularly strong association with shorter HF-free survival, as those without diabetes lived on average between 8.6 and 10.6 years longer without HF. Men at age 45 years without any of the three risk factors lived an average of 10.6 years longer free of HF, while women at age 45 without any of the three risk factors lived an average of 14.9 years longer without HF. White and black participants without risk factors lived 12.4 and 12.9 years longer, respectively. Similar trends were seen for index age 55 years.

"Although advancing the care of patients with established HF remains an important objective, figuring out how to maximize the number of years free of disease is just as critical," writes Thomas J. Wang, MD, FACC, in an editorial comment accompanying the study. "As the study by Ahmad et al. nicely emphasizes, delaying the onset of HF should involve not only arresting disease pathogenesis in its early stages (primary prevention), but also preventing the development of key risk factors in the first place (primordial prevention)."


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