Heart Failure Risk Factors and Survival

Study Questions:

Does absence of hypertension, diabetes (DM), and obesity by mid-life impact incident heart failure and heart failure-free survival?


This analysis was performed using a sample from the Cardiovascular Lifetime Risk Pooling Project, a pooled data set of 20 US-based community epidemiological cohorts. Participants were stratified based on race, gender, and presence of the following risk factors: hypertension, diabetes, and obesity. Incident heart failure risk, heart failure-free survival, overall survival, and percentage of lives lived without heart failure, were determined at index ages 45 and 55 years.


A total of 19,249 participants at age 45 years and 23,915 participants at age 55 years were included in this analysis. Women comprised approximately 50% of the sample at both ages. Blacks comprised 9.6% at age 45 and 12% at age 55. In general, black participants had substantially higher prevalence of individual and multiple risk factors than other subgroups at both index ages. At age 45, 36.1%of black participants were free of all risk factors compared with 55% of whites, and 4% of blacks had all three risk factors compared with 0.7% of whites. Compared to participants with all three risk factors, the absence of all risk factors at age 45 years was associated with a 73-88% lower risk of incident heart failure. Absence of risk factors was also associated with significantly longer heart failure-free survival (except in black participants with obesity and hypertension). Absence of diabetes had the greatest impact on heart failure-free survival. At age 45, men and women without DM lived on average 8.6 and 10.6 years longer without heart failure, respectively, than those with DM, and black and white participants without DM lived an average 10.3 and 8.6 years longer free from heart failure than those with DM. Participants without risk factors lived a lower proportion of their lives with heart failure in the context of prolonged survival.


Avoidance of diabetes, hypertension, and obesity by ages 45 and 55 is associated with substantially lower incidence of heart failure, longer heart failure-free survival, and increased overall survival.


In this study, the absence of diabetes, hypertension, and obesity by ages 45 and 55, compared with the presence of all three risk factors, was associated with decreased risk of heart failure, increased survival, and increased heart failure-free survival. Prevention of risk factors by mid-life is essential in preventing disease and heart failure-related morbidity, and may decrease the public health impact of heart failure.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: African Americans, Cardiovascular Diseases, Diabetes Mellitus, Heart Failure, Hypertension, Obesity, Primary Prevention, Risk Factors, Survival

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