W.H. Wilson Tang, MD; Gary S. Francis, MD


J Am Coll Cardiol. 2010;55(7):688-696. 

In This Article


Recent epidemiologic data have drawn attention to the importance of preventing HF by implementing lifestyle modifications long before HF is manifested. The Health ABC (Health Aging, Body, and Composition) study observed an incidence of 13.6 cases of HF per 1,000 person-years in the elderly population, with men and black participants being more likely to develop incident HF. Interestingly in this contemporary cohort, a large proportion of the HF mortality and rehospitalizations were associated with modifiable risk factors. This observation was also made in the Physicians' Health Study. In this study of 20,900 middle-age healthy men, those who had normal body weight, never smoked, got regular exercise, drank alcohol in moderation, and consumed breakfast cereal and fruits and vegetables had an associated lower lifetime risk of developing HF.[3]

Racial and sex differences in the development and progression of HF have been explored in several publications. In the Health ABC study, 6 of 8 modifiable risk factors (smoking, increased heart rate, coronary heart disease, left ventricular hypertrophy, uncontrolled blood pressure, and reduced glomerular filtration rate) were more prevalent in black participants compared with white participants,[4] especially in the younger patient population.[5] It is alarming that up to 1 in 100 black men and women age <50 years may develop HF, with hypertension and renal failure as the major determinants. However, the strongest determinant of prognosis in patients hospitalized for HF was neither race nor sex, but advancing age.[6,7]