Heart Failure: What Are the Risk Factors?

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The MD Magazine Peer Exchange: Advances in Heart Failure Management features expert opinion and analysis from leading physician specialists on the latest developments in heart failure research, diagnosis, and management.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Michael Felker, MD, MHS, Professor of Medicine, Chief of the Heart Failure Section, Director of the Heart Center Clinical Research Unit, and Director of the Advanced Heart Failure Fellowship at Duke University School of Medicine
• Jim Januzzi, MD, Roman W. DeSanctis Endowed Distinguished Clinical Scholar in Medicine at Massachusetts General Hospital and Hutter Professor of Medicine at Harvard Medical School
• Christian Schulze, MD, PhD, Associate Professor of Medicine, Division of Cardiology at Columbia University Medical Center, and Director of Research for the Center of Advanced Cardiac Care at Columbia University Medical Center

In the opening segment of this Peer Exchange, the panelists discuss the pathophysiology, etiology, and epidemiology of heart failure. They also begin a discussion on important risk factors to look for and then emerging treatment options that may help improve outcomes in the near future.

Dr. Felker notes that heart failure is “a common manifestation of all sorts of cardiovascular diseases. So the same things that are risk factors for cardiovascular disease in general are likely to lead to heart failure.” Some risk factors, such as family history and genetics, are not modifiable, but others (such as diet, lipid profile, smoking, and level of physical activity) are very modifiable risk factors.

Dr. Januzzi says that it is “important to emphasize the American Heart Association has drilled down on a number of important risk factors that predict future heart failure and they really speak to better living, with is focused on weight loss, control of blood pressure, and other things that are modifiable. As we articulated in the ACC/AHA Guidelines, the ultimate way to treat heart failure is to prevent it.”

Although the AHA has provided a detailed list of healthy behaviors that patients can do to improve their cardiovascular health, Dr. Felker says the data shows that it is “an incredibly tiny percentage” of Americans who actually follow all those healthy behaviors, and “those are the people who probably have very low risk anyway.” He says that when it comes to lifestyle modification and heart failure in the US, “we have a long ways to go.”