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Risk Factors for Heart Failure in Young Adults

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Abstract

Heart failure (HF) is now recognized as a progressive disorder that typically begins with an asymptomatic state in patients with risk factors (Stage A), proceeds to developing structural abnormalities (Stage B), following which symptoms commonly develop (Stages C and D) unless treatment is initiated. Risk factors for developing HF include hypertension, diabetes mellitus, obesity, and risk factors for coronary artery disease including smoking and hypercholesterolemia. Although the incidence of HF in young adults is very low, they have a high lifetime incidence of developing HF (approximately one in five). The landmark CARDIA study found that risk factors for HF in young adults were similar to those seen in older adults. To decrease the future burden of HF it is essential to identify and intervene in those patients at risk, namely those in Stages A and B.

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References

Papers of particular interest, published recently, have been highlighted as follows: • Of major importance •• Of major importance

  1. Massie BM, Shah NB: Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 1997, 133:703–712.

    Article  CAS  PubMed  Google Scholar 

  2. American Heart Association: Heart Disease and Stroke Statistics—2005 Update. Dallas, TX: American Heart Association; 2005.

    Google Scholar 

  3. Hunt SA, Abraham WT, Chin MH, et al.: 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009, 53:e1–e90. (Published erratum appears in J Am Coll Cardiol 2009, 54:2464.)

    Google Scholar 

  4. Seidman JG, Seidman C: The genetic basis for cardiomyopathy: from mutation identification to mechanistic paradigms. Cell 2001, 104:557–567.

    Article  CAS  PubMed  Google Scholar 

  5. Masoudi FA, Havranek EP, Krumholz HM: The burden of chronic congestive heart failure in older persons: magnitude and implications for policy and research. Heart Fail Rev 2002, 7:9–16.

    Article  PubMed  Google Scholar 

  6. Braunwald E: Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997, 337:1360–1369.

    Article  CAS  PubMed  Google Scholar 

  7. Levy D, Kenchaiah S, Larson MG, et al.: Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002, 347:1397–1402.

    Article  PubMed  Google Scholar 

  8. Roger VL, Weston SA, Redfield MM, et al.: Trends in heart failure incidence and survival in a community-based population. JAMA 2004, 292:344–350.

    Article  CAS  PubMed  Google Scholar 

  9. McCullough PA, Philbin EF, Spertus JA, et al.; Resource Utilization Among Congestive Heart Failure (REACH) Study: Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002, 39:60–69.

    Article  PubMed  Google Scholar 

  10. Redfield MM: Heart Failure—an epidemic of uncertain proportions. N Engl J Med 2002, 347:1442–1444.

    Article  PubMed  Google Scholar 

  11. Lloyd-Jones DM, Larson MG, Leip EP, et al.; Framingham Heart Study: Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 2002, 106:3068–3072.

    Article  PubMed  Google Scholar 

  12. Bleumink GS, Knetsch AM, Sturkenboom MC, et al.: Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam Study. Eur Heart J 2004, 25:1614–1619.

    Article  PubMed  Google Scholar 

  13. Jessup M, Brozena S: Heart failure. N Engl J Med 2003, 348:2007–2018.

    Article  PubMed  Google Scholar 

  14. • Dunlay SM, Weston SA, Jacobsen SJ, Roger VL: Risk factors for heart failure: a population-based case-control study. Am J Med 2009, 122:1023–1028. This article found that the mean number of risk factors per HF case in Olmstead County was 1.9.

    Article  PubMed  Google Scholar 

  15. • Folsom AR, Yamagishi K, Hozawa A, et al.: Absolute and attributable risks of heart failure incidence in relation to optimal risk factors. Circ Heart Fail 2009, 2:11–17. This article categorized risk factors in the ARIC cohort. Middle-aged adults with optimal risk factors had low incidence rates of HF. Having at least one elevated risk factor of the five risk factors studied accounted for 89% of HF events.

    Article  PubMed  Google Scholar 

  16. Nicholls MG: Hypertension, hypertrophy, heart failure. Heart 1996, 76:92–97.

    Article  CAS  PubMed  Google Scholar 

  17. Clawson BJ: Incidence of types of heart disease among 30,265 autopsies, with special reference to age and sex. Am Heart J 1941, 22:607–624.

    Article  Google Scholar 

  18. Kannel WB, Castelli WP, McNamara PM, et al.: Role of blood pressure in the development of congestive heart failure. The Framingham study. N Engl J Med 1972, 287:781–787.

    Article  CAS  PubMed  Google Scholar 

  19. Levy D, Larson MG, Vasan RS, et al.: The progression from hypertension to congestive heart failure. JAMA 1996, 275:1557–1562.

    Article  CAS  PubMed  Google Scholar 

  20. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 1970, 213:1143–1152.

    Article  Google Scholar 

  21. Kostis JB, Davis BR, Cutler J, et al., for the SHEP Cooperative Research Group: Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1997, 278:212–216.

    Article  CAS  PubMed  Google Scholar 

  22. Baker DW: Prevention of heart failure. J Card Fail 2002, 8:333–346.

    Article  PubMed  Google Scholar 

  23. Chobanian AV, Bakris GL, Black HR, et al.: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206–1252.

    Article  CAS  PubMed  Google Scholar 

  24. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997. (Published erratum appears in JAMA 2003, 289:178 and JAMA 2004, 291:2196.)

    Article  Google Scholar 

  25. Davis BR, Cutler JA, Furberg CD, et al.; ALLHAT Collaborative Research Group: Relationship of antihypertensive treatment regimens and change in blood pressure to risk for heart failure in hypertensive patients randomly assigned to doxazosin or chlorthalidone: further analyses from the Antihypertensive and Lipid-Lowering treatment to Prevent Heart Attack Trial. Ann Intern Med 2002, 137:313–320.

    CAS  PubMed  Google Scholar 

  26. Kannel WB, McGee DL: Diabetes and cardiovascular disease. The Framingham study. J Am Med Assoc 1979, 214:2035–2038.

    Article  Google Scholar 

  27. Chae CU, Glynn RJ, Manson JE, et al.: Diabetes predicts congestive heart failure risk in the elderly. Circulation 1998, 98:721.

    Google Scholar 

  28. Krumholz HM, Chen YT, Wang Y, et al.: Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J 2000, 139:72–77.

    Article  CAS  PubMed  Google Scholar 

  29. Shindler DM, Kostis JM, Yusuf S, et al.: Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol 1996, 77:1017–1020.

    Article  CAS  PubMed  Google Scholar 

  30. Devereux RB, Roman MJ, Paranicas M, et al.: Impact of diabetes on cardiac structure and function: the Strong Heart Study. Circulation 2000, 101:2271–2276.

    CAS  PubMed  Google Scholar 

  31. Taegtmeyer H, McNulty P, Young ME: Adaptation and maladaptation of the heart in diabetes: Part I: general concepts. Circulation 2002, 105:1727–1733.

    Article  CAS  PubMed  Google Scholar 

  32. Johnstone MT, Creager SJ, Scales KM, et al.: Impaired endothelium-dependent vasodilation in patients with insulin-dependent diabetes mellitus. Circulation 1993, 88:2510–2516.

    CAS  PubMed  Google Scholar 

  33. Williams SB, Cusco JA, Roddy MA, et al.: Impaired nitric oxide-mediated vasodilation in patients with non-insulin dependent diabetes mellitus. J Am Coll Cardiol 1996, 27:567–574.

    Article  CAS  PubMed  Google Scholar 

  34. Mizushige K, Yao L, Noma T, et al.: Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 2000, 101:899–907.

    CAS  PubMed  Google Scholar 

  35. Haffner SM, Lehto S, Rönnemaa T, et al.: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339:229–234.

    Article  CAS  PubMed  Google Scholar 

  36. Jaffee AS, Spadero JJ, Schectman K, et al.: Increased congestive heart failure after myocardial infarction of modest extent in patients with diabetes mellitus. Am Heart J 1984, 108:31–37.

    Article  Google Scholar 

  37. Woodfield SL, Lundergan CF, Reiner JS, et al.: Angiographic findings and outcome in diabetic patients treated with thrombolytic therapy for acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol 1996, 28:1661–1669.

    Article  CAS  PubMed  Google Scholar 

  38. Yusuf S, Sleight P, Pogue J, et al., for The Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153. (Published erratum appears in N Engl J Med 2000, 342:748 and N Engl J Med 2000, 342:1376.)

    Article  CAS  PubMed  Google Scholar 

  39. Kenchaiah S, Evans JC, Levy D, et al.: Obesity and the risk of heart failure. N Engl J Med 2002, 347:305–313.

    Article  PubMed  Google Scholar 

  40. Sattar N, Gaw A, Scherbakova O, et al.: Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003, 108:414–419.

    Article  CAS  PubMed  Google Scholar 

  41. Massie BM: Obesity and heart failure—risk factor or mechanism? N Engl J Med 2002, 347:358–359.

    Article  PubMed  Google Scholar 

  42. Bahrami H, Bluemke DA, Kronmal R, et al.: Novel metabolic risk factors for incident heart failure and their relationship with obesity: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 2008, 51:1775–1783.

    Article  CAS  PubMed  Google Scholar 

  43. Zhou YT, Grayburn P, Karim A, et al.: Lipotoxic heart disease in obese rats: implications for human obesity. Proc Natl Acad Sci U S A 2000, 97:1784–1789.

    Article  CAS  PubMed  Google Scholar 

  44. Gheorghiade M, Bonow RO: Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 1998, 97:282–289.

    CAS  PubMed  Google Scholar 

  45. Mancini GB, Henry GC, Macaya C, et al.: Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease: the TREND (Trial on Reversing Endothelial Dysfunction) Study. Circulation 1996, 94:258–265. (Published erratum appears in Circulation 1996, 94:1490.)

    CAS  PubMed  Google Scholar 

  46. Treasure CB, Klein JL, Weintraub WS, et al.: Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995, 332:481–487.

    Article  CAS  PubMed  Google Scholar 

  47. Vasan RS, Benjamin EJ, Levy D: Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995, 26:1565–1574.

    Article  CAS  PubMed  Google Scholar 

  48. Aroesty JM, McKay RG, Heller GV, et al.: Simultaneous assessment of left ventricular systolic and diastolic dysfunction during pacing induced ischemia. Circulation 1985, 71:889–900.

    CAS  PubMed  Google Scholar 

  49. Teng JK, Lin LJ, Tsai LM, et al.: Acute myocardial infarction in young and very old Chinese adults: clinical characteristics and therapeutic implications. Int J Cardiol 1994, 44:29–36.

    Article  CAS  PubMed  Google Scholar 

  50. Fournier JA, Sánchez A, Quero J, et al.: Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol 1996, 19:631–636.

    Article  CAS  PubMed  Google Scholar 

  51. Cole JH, Miller JI 3rd, Sperling LS, Weintraub WS: Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003, 41:521–528.

    Article  PubMed  Google Scholar 

  52. Chen-Scarabelli C, Hughes SE, Landon G, et al.: A case of fatal ephedra intake associated with lipofuscin accumulation, caspase activation and cleavage of myofibrillary proteins. Eur J Heart Fail 2005, 7:927–930.

    Article  PubMed  Google Scholar 

  53. Yeh ET, Bickford CL: Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol 2009, 53:2231–2247.

    Article  CAS  PubMed  Google Scholar 

  54. Redfield MM, Jacobsen SJ, Burnett JC Jr, et al.: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194–202.

    Article  PubMed  Google Scholar 

  55. Wang TJ, Levy D, Benjamin EJ, Vasan RS: The epidemiology of “asymptomatic” LV systolic dysfunction: implications for screening. Ann Intern Med 2003, 138:907–916.

    PubMed  Google Scholar 

  56. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators. N Engl J Med 1992, 327:685–691. (Published erratum appears in N Engl J Med 1992, 327:1768.)

  57. Moss AJ, Zareba W, Hall WJ, et al.; Multicenter Automatic Defibrillator Implantation Trial II Investigators: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002, 346:877–883.

    Article  PubMed  Google Scholar 

  58. Bonow RO, Carabello B, de Leon A Jr, et al.: Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 1998, 98:1949–1984.

    CAS  PubMed  Google Scholar 

  59. Greenberg B, Massie B, Bristow JD, et al.: Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial. Circulation 1988, 78:92–103.

    CAS  PubMed  Google Scholar 

  60. Scognamiglio R, Rahimtoola SH, Fasoli G, et al.: Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994, 331:689–694.

    Article  CAS  PubMed  Google Scholar 

  61. •• Bibbins-Domingo K, Pletcher MJ, Lin F, et al.: Racial differences in incident heart failure among young adults. N Engl J Med 2009, 360:1179–1190. This prospective study found that the incidence of HF before the age of 50 years was much more common in blacks than whites. HF was associated with higher systolic and diastolic blood pressure, higher BMI, presence of diabetes, and presence of chronic kidney disease. Echocardiographically determined abnormal LV systolic function and LV hypertrophy were both strongly associated with the future development of HF.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Julius M. Gardin.

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Landzberg, J., Gardin, J.M. Risk Factors for Heart Failure in Young Adults. Curr Cardio Risk Rep 4, 128–135 (2010). https://doi.org/10.1007/s12170-010-0079-7

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