Risk factors for heart failure

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Many factors can increase a person’s risk of developing heart failure.

Aging can weaken and stiffen the heart. People age 65 years or older have a higher risk of heart failure.

Certain populations are also at higher risk of heart failure than others. For example, according to the National Heart, Lung, and Blood Institute (NHLBI), Black and African American people are more likely to develop heart failure than people of other races. They may also experience it more severely at a younger age.

Additionally, certain conditions and diseases may increase the risk of heart failure, including:

• coronary artery disease (CAD)
• heart attack
• heart valve disease
• congenital heart disease
• irregular heart rhythms (arrhythmias)
• heart inflammation
• cardiomyopathy
• high blood pressure
• diabetes
• sleep apnea
• chronic kidney disease
• anemia
• overactive or underactive thyroid
• certain viral infections, such as HIV or SARS-CoV-2
• a buildup of iron or protein

Some medications may raise the risk of heart failure, including:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin
• calcium channel blockers
• anticancer medications, such as radiation therapy and chemotherapy
• high blood pressure medications
• vasodilators, such as minoxidil
• diabetes medications, such as metformin and thiazolidinediones
• anti-infection medications, such as antifungal and antimalarial drugs
• some anesthetics, such as ketamine
• eye medications, such as topical beta-blockers
• psychiatric medications, such as antidepressants, sedatives, and neurological medications
• certain decongestants

People should never stop taking prescribed medications without first speaking with a healthcare professional.

Certain behaviors or lifestyle habits may also increase the risk of heart failure, including:

• eating foods high in fat, sodium, and cholesterol
• smoking tobacco
• drinking excessive amounts of alcohol
• taking illegal drugs, such as cocaine and methamphetamine
• not getting enough physical activity

The below sections discuss some of these risk factors in more detail.

CAD, also known as ischemic heart disease, is the most common type of heart disease. It occurs when plaque builds up in the walls of the arteries that supply blood to the heart and other areas of the body.

Plaque consists of cholesterol and other substances. Over time, it causes the arteries to narrow, partially or entirely blocking blood flow. Doctors call this atherosclerosis.

People with CAD typically have chest pain and discomfort. For many people, a heart attack is the first indication of CAD.

CAD gradually weakens the heart muscle, which may lead to heart failure.

Diabetes is a disease that affects how the body uses blood sugar. The most common types of diabetes are type 1, type 2, and gestational. Diabetes can lead to too much sugar in the blood, resulting in various health problems, such as nerve damage, vision problems, and kidney disease.

Over time, high blood sugar can also damage the blood vessels and nerves that supply the heart, increasing the risk of heart failure.

A 2019 scientific statement from the American Heart Association and the Heart Failure Society of America states that type 2 diabetes and heart failure independently raise the risk for the other and often occur together.

People with type 2 diabetes are around 2–4 times more likely to develop heart failure than those without diabetes.

Learn more about the effects of diabetes on the body and organs.

High blood pressure, or hypertension, occurs when a person’s blood pressure is higher than normal. It is typical for blood pressure to rise and fall throughout the day. However, when a person’s blood pressure consistently measures above normal, a doctor may diagnose high blood pressure.

High blood pressure can cause the blood vessels to narrow and constrict, meaning the heart has to work harder to pump blood. The heart thickens and enlarges to cope with the increased demand.

The enlarged heart still pumps blood but becomes less efficient. Eventually, the heart cannot pump enough blood to meet the body’s needs, resulting in heart failure.

Research indicates that obesity is a major risk factor for high blood pressure, cardiovascular disease, and the thickening of the walls of the heart’s main pumping chamber, the left ventricle. These are all significant risk factors for heart failure.

The connection between obesity and heart failure is complex. Studies have found that although obesity increases heart failure risk, once a doctor diagnoses the condition, people with heart failure and obesity have better outcomes than people without obesity. Researchers call this phenomenon the obesity paradox.

Experts have suggested various explanations for the obesity paradox, including that fat could be protective against further health complications and death after a person develops heart problems.

However, in a 2023 study revisiting the obesity paradox, researchers found that when using better ways of measuring fat, the top 20% of participants with the most fat were at a 39% higher risk of hospitalization for heart failure than people in the bottom 20% with the least fat.

Various heart conditions can increase a person’s chances of heart failure. These may include:

• Heart attack: A heart attack, also called a myocardial infarction, occurs when there is a sudden partial or complete blockage to the heart’s blood supply. A heart attack can extensively damage the heart muscle and weaken its pumping ability, leading to heart failure.
• Heart valve disease: Valvular heart disease involves problems with one or more of the four heart valves, preventing the heart from effectively pumping blood throughout the body. When the heart has to work harder to pump, it can result in heart failure.
• Congenital heart disease: People with congenital heart disease have had structural issues with their heart since birth. Heart failure is the leading cause of complications in adults with congenital heart disease.
• Arrhythmias: An arrhythmia is a problem with the rate or rhythm of a person’s heartbeat. It can involve a heart rate that is too fast, too slow, or irregular. Without treatment, arrhythmias can damage the heart, leading to heart failure.
• Heart inflammation: Inflammation is the heart’s natural reaction to injury or infection. Heart inflammation can affect the lining of the heart or valves, the tissue surrounding the heart, and the heart muscle, resulting in severe heart problems, such as heart failure.
• Cardiomyopathy: Depending on the type of cardiomyopathy, the heart muscle may become larger, thicker, or stiffer than usual, making it harder for the heart to pump blood. People may experience symptoms of heart failure in the later stages of cardiomyopathy when the heart weakens.

Some behaviors may increase the risk of heart failure. These include the following:

Diet

Experts link diets high in trans fat, saturated fats, and cholesterol with risk factors for heart failure, including heart disease and related conditions, such as atherosclerosis.

A diet high in sodium can increase blood pressure. It can also increase the amount of fluid the body holds onto, which can lead to heart failure through high blood pressure. It can also exacerbate existing heart failure.

Smoking

Smoking damages almost every organ in the body, including the heart. The chemicals people inhale from smoking damage the heart and blood vessels, increasing the chances of atherosclerosis. Even occasional smoking can cause damage.

A 2022 study found that cigarette smoking doubles a person’s risk of developing heart failure. Researchers also found that the elevated heart failure risk persisted for decades after people quit smoking.

Alcohol

Researchers recognize that long-term excessive alcohol consumption may cause a type of heart failure known as alcoholic cardiomyopathy. However, there is little evidence to suggest that light or moderate drinking directly worsens heart failure.

Heavy drinking could indirectly worsen heart failure and its related symptoms. This is because heavy drinking can raise heart rate and elevate blood pressure, risk factors for heart failure.

Substances

Many substances can adversely affect the heart.

For example, people who use cocaine are more likely to have higher blood pressure, thicker heart muscle walls, and stiffer arteries than those who do not use the drug.

Additionally, cannabis misuse may cause heart problems by affecting heart rate, blood pressure, and medication interactions.

A 2020 study also indicates that misuse of opioids and methamphetamines is independently associated with a higher risk of hospitalizations for heart failure.

People may be able to lower their risk of heart failure by:

• quitting smoking
• eating a healthy diet emphasizing fruits and vegetables, whole grains, and healthy protein sources
• minimizing processed foods.
• preparing foods with little or no salt
• limiting alcohol intake
• avoiding misusing substances
• participating in a regular physical activity program
• working with healthcare professionals to manage conditions that increase the risk of heart failure, such as diabetes

Many factors increase a person’s risk of developing heart failure.

The most common risk factors for heart failure include CAD, diabetes, and high blood pressure.

People may be able to reduce their risk of heart failure by making dietary and lifestyle changes.