Current Cardiology Reports

, Volume 3, Issue 3, pp 184–190 | Cite as

The risk of congestive heart failure: sobering lessons from the framingham heart study

  • Donald M. Lloyd-Jones
Article

Abstract

This review highlights recent contributions of the Framingham Heart Study to our understanding of the epidemiology of congestive heart failure (CHF). Given its uniform criteria for the diagnosis of CHF and its long duration of follow-up, the Framingham study has had a unique perspective on the short- and long-term risk of developing CHF, its predisposing risk factors, and its prognosis in a general, community-based population. Some recent studies from Framingham have provided important insights on CHF: the lifetime risk is estimated to be 20% for men and women; hypertension is the most important modifiable risk factor, with a population-attributable risk of CHF of 59% for women and 39% for men; a clinical prediction rule for development of CHF has recently been published; and the prognosis after development of CHF is grim, with a median survival of 1.7 years in men and 3.2 years in women.

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References and Recommended Reading

  1. 1.
    Braunwald E: Shattuck Lecture. Cardiovascular medicine at the turn of the millennium: triumphs, bdconcerns, bdand opportunities. N Engl J Med 1997, 337:1360–1369.PubMedCrossRefGoogle Scholar
  2. 2.
    American Heart Association: 2001 Heart and Stroke Statistical Updatev. Dallas: American Heart Association; 2000.Google Scholar
  3. 3.
    Goldberg RJ, Konstam MA: Assessing the population burden from heart failure: need for sentinel population-based surveillance systems. Arch Intern Med 1999, 159:15–17.PubMedCrossRefGoogle Scholar
  4. 4.
    McKee PA, Castelli WP, McNamara PM, Kannel WB: The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971, 285:1441–1446.PubMedCrossRefGoogle Scholar
  5. 5.
    Senni M, Triboiuilloy CM, Rodeheffer RJ, et al.: Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998, 98:2282–2289.PubMedGoogle Scholar
  6. 6.
    Senni M, Triboiuilloy CM, Rodeheffer RJ, et al.: Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch Intern Med 1999, 159:29–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Remes J, Reunanen A, Aromaa A, Pyorala K: Incidence of heart failure in eastern Finland: a population-based surveillance study. Eur Heart J 1992, 13:588–593.PubMedGoogle Scholar
  8. 8.
    Ho KKL, Pinsky JL, Levy D: The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993, 22(Suppl A):6A-13A.PubMedCrossRefGoogle Scholar
  9. 9.
    Kannel WB: Epidemiological aspects of heart failure. Cardiol Clin 1989, 7:1–9.PubMedGoogle Scholar
  10. 10.
    Lloyd-Jones DM, Larson MG, Beiser A, et al.: Lifetime risk of developing congestive heart failure [abstract]. Circulation 1999, 100(Suppl I):I396.Google Scholar
  11. 11.
    Lloyd-Jones DM, Larson MG, Beiser A, Levy D: Lifetime risk of developing coronary heart disease. Lancet 1999, 353:89–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Seshadri S, Wolf PA, Beiser A, et al.: Lifetime risk of dementia and Alzheimer’s disease: the impact of mortality on risk estimates in the Framingham Study. Neurology 1997, 49:1498–1504.PubMedGoogle Scholar
  13. 13.
    Lloyd-Jones DM, Larson MG, Beiser A, et al.: High blood pressure contributes to increased lifetime risk of congestive heart failure [bdabstract]. Circulation 2000, 102(Suppl II):II844.Google Scholar
  14. 14.
    Levy D, Larson MG, Vasan RS, et al.: The progression from hypertension to congestive heart failure. JAMA 1996, 275:1557–1562. An elegant examination of the role that hypertension plays in the development of CHF. In this study, 91% of subjects with CHF had antecedent hypertension. The multivariate-adjusted hazard ratios and population-attributable risks for key risk factors for CHF are presented and discussed, as is the prognosis after development of CHF.PubMedCrossRefGoogle Scholar
  15. 15.
    Kannel WB, D’Agostino RB, Silbershatz H, et al.: Profile for estimating risk of heart failure. Arch Intern Med 1999, 159:1197–1204. The authors developed a multivariate model and clinical prediction rule to assess the risk of developing CHF within 4 years in subjects with predisposing factors of coronary heart disease, hypertension, or valvular heart disease.PubMedCrossRefGoogle Scholar
  16. 16.
    Freed LA, Levy D, Levine RA, et al.: Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 1999, 341:1–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Vasan RS, Larson MG, Benjamin EJ, et al.: Left ventricular dilation and the risk of congestive heart failure in people without myocardial infraction. N Engl J Med 1997, 336:1350–1355.PubMedCrossRefGoogle Scholar
  18. 18.
    Galderisi M, Anderson KM, Wilson PWF, Levy D: Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (the Framingham Heart Study). Am J Cardiol 1991, 68:85–89.PubMedCrossRefGoogle Scholar
  19. 19.
    Vasan RS, Larson MG, Benjamin EJ, et al.: Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a populationbased cohort. J Am Coll Cardiol 1999, 33:1948–1955. This nested case-control study examined the prevalence of normal (51%) versus reduced (49%) left ventricular systolic function among subjects with CHF, and the outcomes associated with each clinical picture. Although the absolute annual mortality was lower among subjects with normal systolic function compared with reduced systolic function, the relative hazard ratios were the same when each group was compared with matched controls.PubMedCrossRefGoogle Scholar
  20. 20.
    Ho KKL, Anderson KM, Kannel WB, et al.: Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993, 88:107–115.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Donald M. Lloyd-Jones
    • 1
  1. 1.Cardiology DivisionMassachusetts General HospitalBostonUSA

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