An estimated 15 million Americans are at risk of developing heart failure, according to a new report.
The study, published on December 17 Annals of Internal Medicineuses newly developed equations that, for the first time, allow scientists to better predict a person’s risk of developing the condition.
Heart failure occurs when the heart weakens and is no longer able to meet the needs of the body. People with heart failure experience symptoms such as frequent fatigue, swelling and fluid accumulation in the legs, and shortness of breath. About 6.7 million Americans currently have this condition.
Until recently, doctors didn’t have effective tools to estimate how many Americans might develop heart failure.
But in 2023, an advisory group of the American Heart Association published a paper describing what they called the Cardiovascular Disease Risk Prediction (PREVENT) Equations. These equations take race out of the equation and incorporate various measures of kidney, social, and metabolic health to better estimate a person’s risk of heart failure.
To apply the new equations, the authors of the new report collected survey data from 4,872 participants between the ages of 30 and 79, representative of the American adult population. Participants were asked to provide information about their gender, age, systolic blood pressure, body mass index (BMI), use of blood pressure medication, diabetes, smoking status, and glomerular filtration rate (used to determine kidney health).
After crunching the numbers, the researchers estimated that 15 million people have at least a 10% risk of developing heart failure in the next decade. They also conducted a similar test and found that about 6.6 million Americans are at risk of developing atherosclerosis, or the buildup of plaque in the arteries.
Of those estimated to be at higher risk of heart failure, 62% are between the ages of 70 and 79. This is consistent with other existing data on heart failure.
“Patterns of people at risk of heart failure generally follow the same patterns seen in patients with heart failure,” study author Timothy Anderson, MDassistant professor of medicine at the University of Pittsburgh, said in a news release. “Age is the biggest driver.”
This was despite the fact that older adults in the study were more likely to have heart failure risk factors, including obesity and diabetes, under control.
“Most older people found to be at risk (of heart failure) do not have any of these modifiable factors,” Francisco Lopez-Jimenez, MDprofessor of medicine and consultant in the Division of Preventive Cardiology at the Mayo Clinic, said Health.
But in addition to age, researchers found that obesity and high blood pressure also play a big role in the risk of heart failure. Just over 55% of people at increased risk had a BMI over 30 kg/m2and about 53% had a systolic blood pressure (the highest number on the reading) above 130 mm Hg.
Elevated levels of hemoglobin A1c (HbA1c) – an indicator of diabetes – was another common risk factor for heart failure, particularly among Hispanic adults. Diabetes is more common in Hispanics, which could explain why it may play a greater role in the development of heart failure for this demographic, Lopez-Jimenez said.
“High blood pressure, elevated BMI, and high HbA1c reflect the deleterious effects of hypertension, obesity, and uncontrolled diabetes on the heart,” Chiadi Ndumele, MD, PhDdirector of obesity and cardiometabolic research and director of the Heart Failure Prevention Program at the Johns Hopkins School of Medicine, said Health. “Each of these conditions causes the heart’s structure and function to deteriorate, contributing to the risk of developing heart failure.”
Current smokers were also at greater risk of heart failure, the report showed. This is because smoking damages the heart and blood vessels and increases the build-up of plaque in the arteries – this can increase the chances of heart failure.
And while race was not a factor in the PREVENTION equations themselves, the data showed that black Americans were overrepresented among those at increased risk of heart failure.
“The authors found a slightly higher prevalence of elevated risk factors among black and Hispanic adults at increased risk of heart failure,” Ndumele said. “This is likely due to the greater burden of negative social determinants of health among Black and Hispanic adults.”
There are several other factors that can increase a person’s risk of heart failure, including coronary artery disease, a heart attack, other heart conditions, a sedentary lifestyle, or an unhealthy diet. Exposure to toxic drugs, family history, sleep apnea and drinking too much alcohol can also increase the risk of heart failure, Ndumele added.
“However, they are not always easily identified in large population databases and contribute less frequently to the risk of heart failure in the (general) population,” he said.
While this new report gives us more insight into how widespread the risk of heart failure is, there are a few limitations to keep in mind.
The baseline data used for this study is based on self-reported information rather than medical records, so there is potential for bias. In addition, the researchers were unable to track the risk scores and confirm their accuracy by tracking who actually developed heart failure over time. They also did not investigate the risk of different types of heart failure.
But while more research is needed, the heart failure predictions in the report point to the importance of keeping modifiable risk factors — especially obesity, diabetes and high blood pressure — under control, experts agreed.
Hypertension, which affects nearly half of American adults, may be a particularly good place to start. There is some evidence that treating high blood pressure can reduce the risk of heart failure by 50% Michele Hamilton, MDprofessor of cardiology at Cedars-Sinai, said Health.
People often don’t feel very sick in the early stages of hypertension, she explained, so it’s easy to sweep it under the rug. Family support, better education and easy access to medical care are key to ensuring people follow interventions to improve heart health, she said.
“This combined approach of maximizing education, access to preventive medical care, and supporting necessary lifestyle changes — smoking cessation, healthy diet, exercise program — is key to overcoming all risk factors and preventing heart failure,” Hamilton said.