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Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study
Abstract
BACKGROUND: The incidence of congestive heart failure (CHF) has been increasing steadily in the United States during the past 2 decades. We studied risk factors for CHF and their corresponding attributable risk in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. PARTICIPANTS AND METHODS: A total of 13 643 men and women without a history of CHF at baseline examination were included in this prospective cohort study. Risk factors were measured using standard methods between 1971 and 1975. Incidence of CHF was assessed using medical records and death certificates obtained between 1982 and 1984 and in 1986, 1987, and 1992. RESULTS: During average follow-up of 19 years, 1382 CHF cases were documented. Incidence of CHF was positively and significantly associated with male sex (relative risk [RR], 1.24; 95% confidence interval [CI], 1.10-1.39; P<.001; population attributable risk [PAR], 8.9%), less than a high school education (RR, 1.22; 95% CI, 1.04-1.42; P =.01; PAR, 8.9%), low physical activity (RR, 1.23; 95% CI, 1.09-1.38; P<.001; PAR, 9.2%), cigarette smoking (RR, 1.59; 95% CI, 1.39-1.83; P<.001; PAR, 17.1%), overweight (RR, 1.30; 95% CI, 1.12-1.52; P =.001; PAR, 8.0%), hypertension (RR, 1.40; 95% CI, 1.24-1.59; P<.001; PAR, 10.1%), diabetes (RR, 1.85; 95% CI, 1.51-2.28; P<.001; PAR, 3.1%), valvular heart disease (RR, 1.46; 95% CI, 1.17-1.82; P =.001; PAR, 2.2%), and coronary heart disease (RR, 8.11; 95% CI, 6.95-9.46; P<.001; PAR, 61.6%). CONCLUSIONS: Male sex, less education, physical inactivity, cigarette smoking, overweight, diabetes, hypertension, valvular heart disease, and coronary heart disease are all independent risk factors for CHF. More than 60% of the CHF that occurs in the US general population might be attributable to coronary heart disease.
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“Similarly, in observational studies (NHANES 64 and ARIC 65 ), the incidence of HF in patients with T2DM was higher than in those without T2DM, with the corresponding hazard ratios (HRs) of 1.85 and 3.54.”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [64]
In the citing paper
“However, in human studies, we mainly have to rely on cross-sectional data at this time, and the conclusions are not firm regarding the direct role of obesity in the development of heart failure (14, 46, 132, 376).”
From Cardiac remodeling in obesity (2008) · cites this paper as [132]
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“Elevated blood pressure significantly increases the risk of heart failure (risk ratio 1.40; 95% confidence interval 1.24–1.59), contributing to approximately 10.1% of cases, as determined by the analysis of the NHANES dataset [33].”
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“It is generally accepted that there is an association between obesity and heart failure, although the pathophysiological mechanism involved remains to be identified [1—3].”
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Comorbidities in Heart Failure
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“There are a few reports that suggest an association between obesity and congestive heart failure (15-18).”
BackgroundRisk of Obstructive Sleep Apnea
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“Similarly, diabetes increases the risk of HF up to 5-fold in women, compared to a doubling of risk in men with diabetes and it imparts a significantly greater risk of death from ischemic heart disease.(18-20) And how should these findings inform our discussions with and recommendations to the middle-aged woman without…”
BackgroundOBESITY AND THE RISK OF HEART FAILURE
Enchaiah, S. A. K., Ané, J. M., Vans, C. E., Evy, D. A. L., Eter, P., Enjamin, E. M. J. B., Arson, M. A. G. L., Annel, W. I. B. K., & Asan, S. (2002) · Cited by 6
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Outcomes and complications of heart failure with iron deficiency anemia: a nationwide analysis
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“Intravenous iron supplementation shows promise in improving functional status and quality of life, shifting the focus away from hemoglobin levels to iron status [6,7].”
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“That abnormality contributes to hypertensive left ventricular hypertrophy (LVH),(1) a clinically relevant sequela of elevated blood pressure (BP),(2) as well as to diseases states such as congestive heart failure (CHF) and acute myocardial infarction (AMI) in which EH acts as a main risk factor.(3,4) However, the asse…”
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A model-agnostic approach for understanding heart failure risk factors
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Sex and Gender-Related Issues in Heart Failure
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[Vitamin D deficiency, left ventricular dysfunction and heart failure].
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The Relationship of Childhood Obesity with Cardiomyopathy and Heart Failure
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Aggelopoulos, P., Chrysohoou, C. A., Pitsavos, C. S., Panagiotakos, D. B., Vaina, S., Brili, S. V., Lazaros, G., Vavouranakis, M., & Stefanadis, C. (2014) · PubMed · Cited by 5
Anesthesia and congestive heart failure: pathology, medical, and surgical management.
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“This is an important consideration when over 60% of heart failure cases may have an underlying ischemic etiology [30].”
BackgroundRisk factors for heart failure in women with ischemia and no obstructive coronary artery disease
Leong, D. W., Tjoe, B., Zarrini, P., Cook‐Wiens, G., Wei, J., SHUFELT, C. L., Pepine, C. J., Handberg, E. M., Reís, S. E., Reichek, N., et al. (2021) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2021.100035 · Cited by 5
“…with no obstructive coronary disease; CMD, coronary micro-vascular dysfunction; WISE, Women's Ischemia Syndrome Evaluation; MACE, major adverse cardiovascular events; HTN, hypertension; DM, diabetes mellitus; CFR, coronary flow reserve. diabetes, tobacco use, and coronary artery disease [5].”
BackgroundCharacteristics of women with type 2 diabetes and heart failure in Spain. The DIABET-IC study
Padial, L. R., Pérez, A., Sánchez, M. A., Barrios, V., Gimeno-Orna, J. A., & Muñiz, J. (2023) · Cardiology Journal · doi:10.5603/cj.a2023.0016 · Cited by 5
“Despite the importance of HF in women, this gender has been less studied in the large trials that have shown prognostic benefit of different drugs in this syndrome, especially in HFrEF [5, 10].”
BackgroundInfluentialIliodromitis, K. E., Tzeis, S. E., Xintarakou, A., Pyrgakis, V. N., Zarifis, Ι., Patsilinakos, S. P., Draganigos, A., Triposkiadis, F. K., Hahalis, G. N., Karanasios, A., et al. (2023) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2023.04.008 · Cited by 5
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Beta-blockers for heart failure
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RetractedThe long-term prognostic significance of heart failure in sarcoidosis patients ─ a cohort study
Etinger, R., Comaneshter, D. S., Amital, H., Cohen, A. D., & Tiosano, S. (2020) · Postgraduate Medicine · doi:10.1080/00325481.2020.1832773 · Cited by 5
Heart Failure in Diabetes mellitus: Clinical Features and Prognostic Implications
Gorelik, O., Almoznino‐Sarafian, D., Alon, I., Shteinshnaider, M., Chachashvily, S., Tzur, I., Modai, D., & Cohen, N. (2005) · Cardiology · doi:10.1159/000084587 · Cited by 5
“The negative impact of diabetes mellitus (DM) on the incidence, prevalence, course and survival of congestive heart failure (CHF) patients has been well established [ , , , ,”
Background
Metadata
- Authors
- He, J., Ogden, L. G., Bazzano, L. A., Vupputuri, S., Loria, C., & Whelton, P. K.
- Affiliations
- Tulane University (US)
- Corresponding author
- He, Jiang
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2001-04-09
- Volume
- 161
- Issue
- 7
- Pages
- 996
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2025266397
- Cited by
- 1,172
- References
- 24
- Citations by year
- 2026: 14 · 2025: 29 · 2024: 38 · 2023: 39 · 2022: 43 · 2021: 51 · 2020: 54 · 2019: 60 · 2018: 61 · 2017: 56 · 2016: 55 · 2015: 61 · 2014: 67 · 2013: 63 · 2012: 66
- FWCI
- 17.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r03hl061954-02, 5r01hl060300-05)
- National Heart, Lung, and Blood Institute (R03 HL-61954, R01HL60300)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- congestive heart failure, risk factors, attributable risk, incidence, sex differences, educational attainment, physical inactivity, cigarette smoking, overweight, hypertension, diabetes mellitus, valvular heart disease, coronary artery disease, coronary revascularization, coronary angioplasty, coronary artery bypass grafting, coronary angiography
- MeSH terms
- Aged, Aged, 80 and over, Coronary Disease, Death Certificates, Educational Status, Female, Follow-Up Studies, Heart Failure, Heart Valve Diseases, Humans, Hypertension, Male, Middle Aged, Nutrition Surveys, Obesity, Risk Factors, Smoking, United States, Exercise, Incidence, Proportional Hazards Models, Sex Distribution, Diabetes Complications
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