Prevention of heart failure risk factors in midlife may prolong disease-free survival
Preventing hypertension, diabetes, and obesity, the major risk factors for heart failure (HF), by ages 45 and 55 years may lower risks of incident HF and prolong HF-free survival, suggests data from the Cardiovascular Disease Lifetime Risk Pooling Project.
“The ability to enjoy more years free of disease is more important for many individuals than simply living longer,” said Dr Thomas Wang of the Division of Cardiovascular Medicine at Vanderbilt University Medical Center in Nashville, Tennessee, US, in a separate editorial. [JACC Heart Fail 2016;4:920-922]
“Delaying the onset of heart failure 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),” he added.
Based on 516,537 person-years of follow-up on participants at age 45 years, 1,677 incident HF occurred. Men and women without any of the three risk factors had 73 percent and 85 percent lower risks of developing HF throughout their lifetimes, respectively, than those with all three risk factors (hazard ratio [HR], 0.27, 95 percent confidence interval [CI], 0.16–0.44 and HR, 0.15, 95 percent CI, 0.10–0.22). [JACC Heart Fail 2016;4:911-919]
Both men and women with none of the risk factors at age 45 years lived for 34.7 years and 38.0 years free of HF, respectively. They also lived an additional 3–15 years longer without experiencing HF, compared with those having either one, two, or three risk factors.
“Diabetes appears to have the strongest association with shorter [HF]-free survival,” said the researchers, noting that men and women with no diabetes lived 8.6 and 10.6 years longer free of HF, respectively, than those who had diabetes.
For each risk factor, HF-free survival and overall survival were significantly different (p<0.00078) between those with and without the specific risk factor at age 45 after stratifying the analyses by sex or age.
Similar trends were observed in participants aged 55 years.
When stratified by race, black participants without any of the risk factors at age 45 were 88 percent less likely to develop HF in their lifetime compared with those with all three risk factors (HR, 0.12, 95 percent CI, 0.07–0.20).
“Although it is not surprising that the avoidance of these [HF] risk factors is associated with lower risk for incident [HF], the magnitude of the associations observed are particularly impressive,” the authors noted. “These data underscore the importance of preventing the development of risk factors in mid-life for decreasing the public health impact of heart failure.”
The pooled analysis sampled data from four cohort studies in the US which contained a total of 19,429 participants aged 45 years and 23,915 participants aged 55 years who were followed on incident HF up to 95 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,” commented Wang.