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Are You at Risk for Heart Failure?

Learn about six factors—including excess weight and certain medications—that could raise your risk of this heart condition.

Medically reviewed in March 2021

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Can you lower your risk for heart failure? In a word: yes.

Granted, some risk factors for this common heart condition, such as family history and congenital heart disease, are out of your control. But there are plenty of lifestyle tweaks you can make to lower your risk. And since heart failure is usually caused by damage that weakens the heart muscle, most often due to cardiovascular disease, the same approaches can also prevent a heart attack.

In fact, men who adopted healthy habits had a lower risk of heart failure compared to those who didn’t, according to an analysis of research published in 2009 in JAMA. Those habits included maintaining a normal body weight, eating a healthy diet, exercising at least five times a week, not smoking and limiting alcohol intake.

Maintaining a healthy lifestyle is “paramount,” says Andrew Behunin, DO, a cardiologist at MountainStar Heart Center at St. Mark’s Hospital, in Salt Lake City, Utah. In his experience, “the most important thing is to get out and be active, because a lot of the other things will come along with that. If you’re active, you’ll be more mindful of your food choices, your blood pressure will improve and you won’t want to smoke.”

Learn more about risk factors for heart failure and what you can do to lower each of them.

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High blood pressure

A blood pressure reading measures the force of your blood flowing through your arteries, the pipelines that carry blood from your heart to other parts of your body. Having high blood pressure forces the heart to work harder to pump blood, which over time can weaken and stiffen the muscle. It also contributes to hardening of the arteries, leading to decreased blood flow to your heart. People with high blood pressure have a higher risk of stroke, heart failure and heart attack.

Lower your risk: Some people may not even know they have high blood pressure, also known as hypertension. So, it’s important for adults to be screened at least every year by a healthcare provider (HCP). In some cases, your HCP may want to measure your blood pressure more frequently.

If you’ve been diagnosed with hypertension, talk to your HCP about treatment options. Since obesity is the leading cause of high blood pressure, it’s important to make lifestyle changes that include managing weight, limiting sodium, eating a well-balanced diet, reducing alcohol intake and staying physically active. All of these will go a long way toward keeping your blood pressure in the healthy range. Your HCP may suggest the use of medications, as well.

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Obesity

Excess weight can raise blood pressure and blood cholesterol. It can also lower HDL (“good” cholesterol) and put strain on the heart.

Lower your risk: Losing 1 kilogram (about 2.2 pounds) of body weight can lower your blood pressure by one point. To drop weight, try these strategies from the American Heart Association (AHA):

  • Set a series of realistic short-term goals to help you reach your long-term goal.
  • Keep a food diary to track how much you eat, aiming to reduce your daily calorie intake.
  • Combine a healthy diet with exercise. Log at least 150 minutes of moderate-intensity physical activity per week—brisk walking, for instance. Work with your HCP to figure out the best type of exercise for you.
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Sleep apnea

When you have this common sleep disorder, your upper airway is repeatedly blocked during sleep, reducing or completely stopping airflow. This could cause life-threatening pauses in breathing that, in turn, can weaken the heart. Sleep apnea can be found in 12 to 53 percent of people who have experienced heart failure. Left undiagnosed or untreated, it can lead to serious complications, including heart attack.

Lower your risk: For most people with heart failure and sleep apnea, treatment generally involves a combination of losing weight and using a continuous positive airway pressure (CPAP) machine. Following a heart-healthy diet and getting regular exercise can be the first steps you take toward weight loss. Treating sleep apnea will also improve your blood pressure, the main risk factor in developing heart failure.

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Smoking

You already know that smoking is bad for you. What you may not know about is the specific damage it does to your heart. With each cigarette, you’re temporarily increasing your heart rate and blood pressure. Smoking contributes to hardening of your arteries and damages muscle tissue directly.

No matter how many years you’ve been smoking, there are plenty of benefits to quitting right now. Once you stop smoking, heart health immediately improves and you start to reduce your risk for cardiovascular disease. In fact, a study published in 2013 in JAMA found that former smokers without diabetes had about half as much risk of developing cardiovascular disease as people who smoke.

“One year after quitting cigarettes, your risk of heart disease is reduced by half,” says Dr. Behunin. Even people who have already had a heart attack can cut their risk of another once they quit.

Lower your risk: If you’re unable to quit smoking on your own, talk to your HCP about available tools. Research suggests that behavioral support—whether it’s face-to-face, by phone or online—and using quit aids, like patches, lozenges, gum or prescription drugs, can be effective treatment.

A 2009 study published in the Archives of Internal Medicine found that participants who used more than one quit aid were most successful in kicking the habit. Specifically, almost 30 percent of those who used a nicotine lozenge and took the prescription drug bupropion stopped smoking. Almost 27 percent of those who used a nicotine patch and nicotine lozenges were still abstaining at the six-month mark.

“There are lots of quit aids, but ultimately there’s no magic bullet,” says Behunin. “What it requires is having a personalized plan—whether it’s going cold turkey with the help of nicotine gum or using prescription medications—and someone like a quit coach who will hold you accountable.”

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Certain medications

If you have risk factors for heart failure, it’s important to talk to your HCP about any medications you take. There are a number of meds that may lead to complications. One example is nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDS (like ibuprofen and naproxen) and prescription varieties can worsen the risk for heart failure for people with underlying cardiovascular issues.

Other medications to discuss with your HCP include some drugs that treat high blood pressure, cancer, arrhythmias, infections and certain blood, neurological, psychiatric, lung, urological and inflammatory conditions.

Lower your risk: Make sure everyone on your healthcare team has a full list of the meds you’re taking. Ask your HCP about any potential interactions or if a medication could increase your risk of a cardiovascular event. They can tell you whether the benefits of continuing a drug are greater than the risks.

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Drinking alcohol

Heavy drinking over a long period of time can increase your risk for heart failure or lead to alcoholic cardiomyopathy, a form of heart disease. Even those who drink in moderation should discuss the risks with their HCP.

Lower your risk: If you drink, do so in moderation only after consulting your HCP. According to the AHA, that means no more than two drinks per day for men and one drink per day for women. Remember: A drink is a 12-ounce beer, a 4-ounce glass of wine, 1 1/2 ounces of 80-proof liquor or 1 ounce of 100-proof liquor. If you don’t drink, there is no health benefit to starting.

Sources:

American Heart Association. “Causes of Heart Failure.” May 31, 2017. Accessed March 15, 2021.
L Djoussé, JA Driver, JM Gaziano. “Relation between modifiable lifestyle factors and lifetime risk of heart failure.” JAMA. 2009 Jul 22;302(4):394-400.
JL Grodin, & WH Tang. “Treatment strategies for the prevention of heart failure.” Current Heart Failure Reports. December 2013. 10(4), 331–340.
American Heart Association. “Changes You Can Make to Manage High Blood Pressure.” November 30, 2017. Accessed March 15, 2021.
RS Velagaleti, MJ Pencina, et al. “Long-term trends in the incidence of heart failure after myocardial infarction.” Circulation. 2008 Nov 11;118(20):2057-62.
American Heart Association. “Body Mass Index (BMI) In Adults.” August 1, 2014. Accessed March 15, 2021.
Centers for Disease Control and Prevention. “Healthy Weight, Nutrition, and Physical Activity: Losing Weight.” August 17, 2020. Accessed March 15, 2021.
American Heart Association. “5 Steps to Lose Weight and Keep It Off.” January 9, 2017. Accessed March 15, 2021.
Mayo Clinic. “Heart Failure.” May 29, 2020. Accessed March 15, 2021.
American College of Cardiology. “Basics of Sleep Apnea and Heart Failure.” February 19, 2013. Accessed March 15, 2021.
Harvard Health Publishing. “How sleep apnea affects the heart.” February 2013. Accessed March 15, 2021.
National Heart, Lung, and Blood Institute. “Sleep Apnea.” 2021. Accessed March 15, 2021.
Centers for Disease Control and Prevention. “Smoking and Cardiovascular Disease.” 2014. Accessed March 15, 2021.
National Heart, Lung, and Blood Institute. “Benefits of quitting smoking outpace risk of modest weight gain.” March 12, 2013.
American Heart Association. “Lifestyle Changes for Heart Failure.” May 31, 2017. Accessed March 15, 2021.
K Walton, TW Wang, et al. “State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers - United States, 2011-2017.” MMWR Morb Mortal Wkly Rep. 2019 Jul 19;68(28):621-626.
UpToDate. “Behavioral approaches to smoking cessation.” February 2021. Accessed March 15, 2021.
American Heart Association. “Is drinking alcohol part of a healthy lifestyle?” December 30, 2019. Accessed March 15, 2021.
MedlinePlus. “Atherosclerosis.” February 26, 2021. Accessed March 29, 2021.
MedlinePlus. “High blood pressure – adults.” February 26, 2021. Accessed March 29, 2021.
PK Whelton, RM Carey, et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Hypertension. November 13, 2017. 2018;71:e13–e115.
HK Khattak, F Hayat, et al. “Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis.” Texas Heart Institute Journal. June 2018. 45(3), 151–161.
National Heart, Lung, and Blood Institute. “Benefits of quitting smoking outpace risk of modest weight gain.” March 12, 2013. Accessed March 29, 2021.
SS Smith, DE McCarthy, et al. “Comparative Effectiveness of 5 Smoking Cessation Pharmacotherapies in Primary Care Clinics.” Archives of Internal Medicine. 2009;169(22):2148–2155.
UpToDate.com. “NSAIDs: Adverse cardiovascular effects.” February 2021. Accessed March 29, 2021.

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