Avoiding Diabetes, Obesity at Midlife Lowers Risk of Heart Failure

Being obese or having high blood pressure or diabetes around age 50 greatly increases the risk of dying earlier from heart failure, according to a study reported in a journal of the American College of Cardiology.

An analysis in JACC: Heart Failure found that avoiding these 3 key risk factors by age 45 to 55 years may lead to an up to 86% lower risk of heart failure for the rest of one’s life. The study team said the results pointed to the need for greater emphasis on preventive medicine to avoid risk factors that contribute to heart failure.

According to recent data from the CDC, heart disease remains the leading cause of death in the United States. Although the number of anticipated deaths fell slightly in the most recent analysis, the aging of the population means that raw numbers continue to climb. While there are many new treatments for heart disease and diabetes, obesity rates have soared over the past 4 decades, and no state has an adult obesity rate below 20%.

Using samples from across the United States, researchers found that at ages 45 and 55 years, respectively, 53.2% and 43.7% of the population had no hypertension, obesity, or diabetes.

Using 45 as the index age, during 516,537 person-years of follow-up, the researchers found 1677 cases of incident heart failure. When using 55 as the index age, they found 2976 cases of heart failure during 502,252 person-years of follow-up.

Avoiding hypertension, obesity, and especially diabetes, greatly reduced the risk of heart failure; this pattern held for both women and men, as well as for both white and black study participants. Of the 3 risk factors, diabetes was most strongly associated with shorter survival without heart failure; those with the disease lived 8.6 to 10.6 years longer without heart failure.

For men, not having any of the 3 risk factors at age 45 meant living 10.6 years longer than other participants without heart failure; for women, making it to age 45 without the risk factors meant living 14.9 years longer without heart failure. Whites without these risk factors at age 45 lived 12.4 years longer, while blacks lived 12.9 years longer. Similar trends were seen for index age 55 years.

"This study adds to the understanding of how individual and aggregate risk factor levels, specifically in middle age, affect incident heart failure risk over the remaining lifespan," senior author John T. Wilkins, MD, MS, of Northwestern University Feinberg School of Medicine, said in a statement. "These findings help reframe the heart failure prevention discussion by quantifying how the prevention of the development of these risk factors can lengthen healthy and overall survival and could vastly reduce the population burden of heart failure."