Framingham, MA - Men and women over the age of 40 have a 1-in-5 lifetime risk of developing congestive heart failure (CHF), a new study suggests. Lifetime risk of CHF declines to 1 in 9 for men who do not have an MI but drops to only 1 in 6 in women without antecedent MIs, a finding that underscores the role of hypertension as an HF etiology, particularly in women.
Given the number of therapies proven to reduce blood pressure in clinical trials, better implementation of these in clinical practice could translate into reduced CHF incidence, Dr Donald M Lloyd-Jones (NHLBI Framingham study) and colleagues write in a rapid access issue of Circulation online November 4, 2002.
"Effective therapies exist for major reductions in CHF incidence if awareness of the problem, identification of high-risk patients, and treatment and control of hypertension can be achieved more widely in clinical practice," they observe.Hypertension and CHF
Lloyd-Jones et al followed 3757 men and 4472 women from 1971 to 1996, during which time 583 people developed heart failure and 2002 died without prior CHF. Remaining lifetime risk for both men and women was approximately 20%, regardless of the person's age. Of note, subjects' lifetime risk of developing CHF if they had not had an MI was almost halved in men, but not in women.
"This small difference in risk indicates that factors other than heart attack play a greater role in women's risk for heart failure," Lloyd-Jones commented in a press statement. "Our data suggest that hypertension is the most important risk factor in women."
Lifetime risk of CHF and of CHF without MI in men and women
Overall risk of CHF: Men (%)
Lifetime risk of CHF without MI: Men (%)
Overall risk of CHF: Women (%)
Lifetime risk of CHF without MI: Women (%)
Other research recently reported by Framingham researchers also singled out hypertension, and specifically improvements in hypertension treatments, as the reason for a decrease in CHF incidence in women but not in men, as reported by heartwire .Multitiered approach warranted
In an editorial that will accompany the study when it appears in print, Drs Salim Yusuf (McMaster University, Hamilton, ON) and Bertram Pitt (University of Michigan, Ann Arbor) point out that both MI and hypertension are "largely preventable using currently known and available strategies."
They hypothesize that the risk of CHF is likely "continuous," such that people with systolic blood pressure (SBP) lower than 120 mm Hg (ie, lower than the lowest SBP assessed by Lloyd-Jones et al) would likely have a lower lifetime risk of CHF than that reported in the current study.
"A 5-mm drop in population systolic BP could in itself reduce the age-specific rates of CHF by at least about one quarter," they calculate. "Primordial" prevention efforts targeting classic risk factors for MI would also improve a range of cardiovascular outcomes, including CHF, they say.
To this end, Yusuf and Pitt call for a multifaceted approach to primary prevention efforts, including changes to urban planning, work habits, and legislation emphasizing the consumption of healthy foods, as well as traditional risk factor modification and use of proven medical therapies such as ACE inhibitors, beta blockers, and spironolactone. One barrier to better prevention efforts, however, is the fact that CHF research has focused predominantly on treatment, not prevention. "Apart from the BP-lowering trials and the prevention trial of the SOLVD study utilizing ACE inhibitors in those with low ejection fraction, there have been no other efforts that have primarily targeted the prevention of heart failure."
Likewise, studies of ICDs and LVADs, while demonstrating important benefits for the very ill, would have only a small impact on the population as a whole, they note.
"It is therefore important that we develop a population-level strategy of prevention of CHF that applies to the large number of 'at-risk' individuals. Such a strategy would complement our current approaches that are aimed at intensive management of patients with manifest CHF."
Heartwire from Medscape © 2002
Cite this: Lifetime risk of HF is 1 in 5 in men and women over 40 - Medscape - Nov 04, 2002.