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Lifetime risk for developing congestive heart failure: the Framingham Heart Study
Donald M Lloyd-Jones1, Martin G Larson, Eric P Leip
1National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Framingham, MA 01702, USA. don@fram.nhlbi.nih.gov
Insights
The lifetime risk for developing congestive heart failure (CHF) is 1 in 5 for both men and women. Hypertension significantly increases this risk, emphasizing the need for blood pressure control.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Congestive heart failure (CHF) represents a growing public health concern with significant morbidity and mortality.
- Understanding the lifetime risk of developing CHF is crucial for effective public health strategies and resource allocation.
Purpose of the Study:
- To determine the lifetime risk of developing overt congestive heart failure (CHF) at various ages.
- To assess the impact of hypertension on the lifetime risk of CHF.
- To evaluate the risk of CHF in the absence of myocardial infarction.
Main Methods:
- Analysis of data from 3757 men and 4472 women in the Framingham Heart Study, followed from 1971 to 1996.
- Calculation of lifetime CHF risk at selected index ages.
- Comparison of CHF risk between subjects with different blood pressure levels and in the absence of myocardial infarction.
Main Results:
- The lifetime risk for CHF at age 40 was 21.0% for men and 20.3% for women.
- Lifetime risk remained consistent across advancing ages due to increasing incidence rates.
- Subjects with blood pressure ≥160/100 mm Hg had double the lifetime risk of CHF compared to those with <140/90 mm Hg.
- The lifetime risk for CHF without prior myocardial infarction was 11.4% for men and 15.4% for women at age 40.
Conclusions:
- Established clinical criteria define a 1 in 5 lifetime risk for CHF in both men and women.
- CHF risk, particularly when occurring without myocardial infarction (1 in 9 for men, 1 in 6 for women), is significantly influenced by hypertension.
- These findings underscore the importance of hypertension control and myocardial infarction prevention in mitigating the population burden of CHF.
Background:
Congestive heart failure (CHF) is an increasing public health problem.
Methods And Results:
Among Framingham Heart Study subjects who were free of CHF at baseline, we determined the lifetime risk for developing overt CHF at selected index ages. We followed 3757 men and 4472 women from 1971 to 1996 for 124 262 person-years; 583 subjects developed CHF and 2002 died without prior CHF. At age 40 years, the lifetime risk for CHF was 21.0% (95% CI 18.7% to 23.2%) for men and 20.3% (95% CI 18.2% to 22.5%) for women. Remaining lifetime risk did not change with advancing index age because of rapidly increasing CHF incidence rates. At age 80 years, the lifetime risk was 20.2% (95% CI 16.1% to 24.2%) for men and 19.3% (95% CI 16.5% to 22.2%) for women. Lifetime risk for CHF doubled for subjects with blood pressure >/=160/100 versus <140/90 mm Hg. In a secondary analysis, we only considered those who developed CHF without an antecedent myocardial infarction; at age 40 years, the lifetime risk for CHF was 11.4% (95% CI 9.6% to 13.2%) for men and 15.4% (95% CI 13.5% to 17.3%) for women.
Conclusions:
When established clinical criteria are used to define overt CHF, the lifetime risk for CHF is 1 in 5 for both men and women. For CHF occurring in the absence of myocardial infarction, the lifetime risk is 1 in 9 for men and 1 in 6 for women, which highlights the risk of CHF that is largely attributable to hypertension. These results should assist in predicting the population burden of CHF and placing greater emphasis on prevention of CHF through hypertension control and prevention of myocardial infarction.
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