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Heart Failure

Causes and Risk Factors for Heart Failure

Heart failure may be due to a variety of factors and causes such as damage to the heart muscle of unknown origin (idiopathic cardiomyopathy), developmental abnormalities (eg, atrial septal defect), thyroid disease (eg, hyperthyroidism), cardiac valve disease, etc. The most common cause of heart failure is ischemic heart disease due to coronary artery atherosclerosis. Recognition and mitigation of the detrimental effects of a variety of contributing factors and conditions may reduce heart failure risk and improve prognosis (NHLBI 2012; Hunt 2005). For heart attack risk, an important risk factor for subsequent heart failure, Life Extension has identified at least 17 independent factors that must be managed to optimally reduce risk. Readers are encouraged to review the Life Extension Magazine article titled How to Circumvent 17 Independent Heart Attack Risk Factors.

Risk factors for heart failure or heart failure progression include (Jessup 2003; Kenchaiah 2004; Heist 2006; Harinstein 2009; McKelvie 2013):

Demographic Risk Factors

Age and gender. Increased age and male gender are consistent risk factors for heart failure, largely due to the increased prevalence of coronary artery disease in these groups (Kenchaiah 2004). However, the prevalence of acute heart failure (heart failure with a rapid onset or that requires urgent treatment) may be comparable in men and women as shown by a survey of approximately 200 000 patients with acute heart failure, of which more than half were women (Harinstein 2009).

Genetics and family history. A family history of heart failure, cardiomyopathy (dysfunction of heart muscle), atherosclerotic disease, arrhythmia, skeletal myopathy (muscle disease involving skeletal muscle), or sudden cardiac death are well-known risk factors for heart failure (Abdel-Qadir 2007; Hunt 2005, Kenchaiah 2004).

Dietary and Lifestyle Risk Factors

Dietary and lifestyle factors associated with increased risk of heart failure include excessive alcohol consumption and nutritional deficiencies (eg, B vitamins) (Dunn 2009; Kenchaiah 2004; Bryson 2006). Smoking represents a major risk factor for developing heart failure, and quitting smoking was shown to have a significant effect on lowering morbidity and the risk of death in people with left ventricular dysfunction, an effect that was comparable to currently approved drugs (Suskin 2001; Conard 2009). Physical inactivity, which is known to be a risk factor for many cardiovascular diseases, was shown to worsen the survival of patients with heart failure; a study reported that 2.5 years after being admitted to the hospital, only 25% of patients with a sedentary lifestyle were alive as compared to 75% of patients who were physically active (Oerkild 2011). Insufficient intake of fruits and vegetables is another risk factor associated with heart failure. In a study that assessed fruit and vegetable intake by way of serum beta-carotene level measurement, men with the lowest beta-carotene blood levels had an almost 3-fold increased risk of heart failure compared to those with the highest intake (Karppi 2013).

Clinical Conditions Associated with Heart Failure

Heart disease. Atrial fibrillation, valve disease (eg, mitral regurgitation), ischemic heart disease due to coronary artery atherosclerosis,  and prior heart attack are associated with an increased risk of heart failure (Kenchaiah 2004; Heist 2006).

Hypertension. Hypertension (high blood pressure) increases heart failure risk 2- to 3-fold (Britton 2009; Kannel 2000). Half of patients with acute heart failure have systolic blood pressure (the “top” number) over 140 mmHg and 70% have a history of high blood pressure (Harinstein 2009). Life Extension’s assessment of the existing medical evidence suggests that for optimal cardiovascular health, most individuals should strive for a target blood pressure of 115/75 mmHg.

Diabetes. Diabetes increases heart failure risk up to five-fold, and 40% of patients with acute heart failure have a history of diabetes (Kenchaiah 2004; Harinstein 2009). Life Extension has identified an optimal fasting glucose level of no more than 85 mg/dL, which is in stark contrast to the acceptance of “normal” fasting glucose readings up to 110 mg/dl. Remember that normal is not the same as optimal.

Chronic obstructive pulmonary disease (COPD). Long-standing obstructive pulmonary disease, often associated with tobacco abuse, is associated with heart failure, and when the two conditions occur simultaneously, prognosis is worse than with either alone (de Miguel Diez 2013).

Renal insufficiency/kidney disease. Evidence suggests that 30% of patients with acute heart failure have severe renal dysfunction (Harinstein 2009).

Overweight/obesity. High body mass index (BMI) is a risk factor for developing heart failure (Vestberg 2013).

Other diseases less well-recognized to be linked with increased heart failure risk include hemochromatosis (iron overload), sarcoidosis, amyloidosis, infection (eg, HIV, pulmonary infection), endocrine disorders (eg, pheochromocytoma), collagen vascular diseases, and sleep apnea (Cutler 1980; Stewart 1988; Hoeper 2002; Farroni 2005; Whooley 2006; Dubrey 2007; Hunt 2009; Falk 2010; Gottlieb 2010; Foley 2012).

Obstructive Sleep Apnea – A Hidden Epidemic with Deadly Consequences

Obstructive sleep apnea is a common and potentially lethal sleep disorder. It results from the upper airway collapsing during sleep, reducing oxygen flow. The resulting low oxygen in the bloodstream arouses the individual, resulting in disrupted sleep (even if they do not fully remember awakening). Between 2 and 7% of adults have obstructive sleep apnea, causing poor sleep quality, snoring, and intractable fatigue (Punjabi 2008; Drager 2011).

This underdiagnosed and often overlooked sleep disorder represents a major risk factor for cardiovascular disease, the leading cause of death in American adults. Data indicate obstructive sleep apnea is associated with a 68% increase in coronary heart disease in men (Gottlieb 2010). Sleep apnea is common among patients with heart failure, and the increased strain on the heart caused by sleep apnea may promote the progression of heart failure (Kasai 2012). Obstructive sleep apnea may also be associated with increased cholesterol, hypertension (Drager 2011; Pedrosa 2011), type 2 diabetes (Aronsohn 2010), cancer mortality (Nieto 2012), stroke, and death (Yaggi 2005).

Pharmacological Risk Factors

Heart failure has been associated with the use of several prescription and non-prescription drugs, including chemotherapeutic agents (doxorubicin, daunorubicin, cyclophosphamide, 5-fluorouracil); cocaine (Kenchaiah 2004); nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin  (Page 2000); thiazolidinediones, a class of drugs used to treat diabetes mellitus, which can lead to fluid retention that may complicate existing heart failure; and doxazosin, a drug used to treat hypertension (Kenchaiah 2004).