Cited by 1,172Heart Failure Treatment and ManagementCardiovascular Health and Risk FactorsCardiovascular Function and Risk Factors

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Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study

He, Jiang, Ogden, Lorraine G., Bazzano, Lydia A., Vupputuri, Suma, Loria, Catherine, Whelton, Paul K.·2001·Archives of Internal Medicine

DOI 10.1001/archinte.161.7.996

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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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“Smoking has previously been estimated to be responsible for 17% of HF cases (30,31), and we also found Figure 5 Paravalvular leakage at 1 year.”
Background
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Figueiró-Filho, E. A., Robinson, N. T., Carvalho, J. C. A., Keunen, J., Robinson, M., & Maxwell, C. V. (2022) · American Journal of Perinatology Reports · doi:10.1055/s-0041-1742270 · Cited by 4
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“Moreover, in accordance with previous studies, we found that males and patients with diabetes treated with doxorubicin-containing regimens were at a higher risk of developing heart failure [6,25,27].”
Result
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Background
Modification to the injection needle to a screw needle improves effective cell delivery in acute myocardial infarction
Hong, K., Byun, K.-H., Seo, J., Lee, H.-J., Choi, J.-J., Kim, K. S., Choi, Y., Moon, S., & Chung, H. (2013) · Biotechnology Letters · doi:10.1007/s10529-013-1414-0 · Cited by 4
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Adipositas und kardiale Kachexie bei chronischer Herzinsuffizienz
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“Prior chronic obstructive lung disease, n (%) 5 (14) 2 (4) 0.”
Background
The effects of adding angiotensin receptor neprilysin inhibitors to usual care in patients with heart failure: a protocol for a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Nielsen, E. E., Feinberg, J. B., Raymond, I. E., Olsen, M. H., Steensgaard-Hansen, F., & Jakobsen, J. C. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1173-7 · Cited by 3
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Physical Activity and Sedentary Time in US Adults with and without Heart Failure: 2007–2018 NHANES
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“…by fibrosis and activation of the neurohormonal cascade, chronic ischemia/hypoperfusion and endothelial dysfunction caused by ongoing coronary atherosclerosis may result in dysfunctional hibernating myocardium and myocardial fibrosis, respectively, ultimately progressing to clinical HF [28 – 30].”
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“25 The Nurses’ Health Study data indicated that a BMI in the range of 25–28.9 had two times the risks for CHD and BMIs of 29 or greater had three times the risk compared to lower BMI values.”
Influential
How 40 kilograms of fluid retention can be overlooked: two case reports
Ong, H. S., Sze, C. W.-C., Koh, T. W., & Coppack, S. W. (2009) · Cases Journal · doi:10.1186/1757-1626-2-33 · Cited by 3
“Introduction The commonest causes of heart failure are ischaemic heart disease, hypertension, diabetes mellitus, and left ventricular hypertrophy [1].”
Background
Heart Failure
Neubauer, B. E., Gray, J. T., & Hemann, B. A. (2018) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2017.11.004 · Cited by 5
Home-Based Multi-parameter Analysis for Early Risk Detection and Management of a Chronic Disease
Goumopoulos, C., & Lappa, A. (2018) · Communications in computer and information science · doi:10.1007/978-3-319-93644-4_3 · Cited by 3
“Relevant literature was explored to determine parameter dependencies and the original conditional probabilities employed in the BN model [11, 26, 27].”
Method
Cardiac and Pulmonary Disorders and the Nervous System
Weathered, N. R. (2020) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000859 · Cited by 3
Análisis de la influencia del Índice de Masa Corporal en la evolución de la Insuficiencia Cardíaca en una Zona de Salud
López, P. J. T. (2020) · Revista Española de Nutrición Humana y Dietética · doi:10.14306/renhyd.24.2.931 · Cited by 3
Heart Failure in Women
Jyotsna, M. (2022) · Indian Journal of Cardiovascular Disease in Women · doi:10.25259/mm_ijcdw_482 · Cited by 4
Influence of physical activity on cognitive functions - Potential mechanisms and benefits
Dwojaczny, B., & Bejtka, M. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.13.03.026 · Cited by 8
Investigation of the effect of concurrently administered carvedilol, atorvastatin and bile salts on intestinal absorption of linagliptin
Embaby, M. A., Maghraby, G. M. E., Osman, M. A., & Sultan, A. A. (2023) · Journal of Pharmacy and Pharmacology · doi:10.1093/jpp/rgad006 · Cited by 3
Pregabalin Does Not Increase Risk of Heart Failure Exacerbation in Patients With Pre-existing Heart Failure
Wynn, E., BISKUPIAK, J. E., Kim, K., & Munger, M. A. (2023) · Annals of Pharmacotherapy · doi:10.1177/10600280231165259 · Cited by 3
Epicardial fat and Stage B heart failure among overweight/obese and normal weight individuals with diabetes mellitus
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Romero, A., Saldarriaga, C., Ramos, C. E., Quesada, D., Chazzin, G., Fernández, F. N. G., Pow-Chon-Long, F., Alarco, W., Hurtado, P. E., Magaña, J. A., et al. (2023) · Archivos de cardiología de México · doi:10.24875/acm.23000059 · Cited by 3
“…como el estudio de Reykjavik 13 , que reportó que la prevalen-cia de la IC era del 12% en los pacientes con diabetes tipo 2 y del 3% en los no diabéticos, o el estudio de seguimiento de la National Health and Nutrition Examination Survey (NHANES), que mostró un riesgo relativo de 1.8 14 .”
Influential
Central Sleep Apnea in Patients With Coronary Heart Disease Taking P2Y12 Inhibitors
Tzeng, W. S., Klein, C. F., Roth, R. H., Cho, Y., MUNAGALA, R. S., Bonner, H., Mazimba, S., Khayat, R., Healy, W., Lobo, J. M., et al. (2023) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000001510 · Cited by 3
“28 The clinical signi ﬁ cance of our ﬁ nding remains speculative.”
Background
Do heart failure status and psychosocial variables moderate the relationship between leisure time physical activity and mortality risk among patients with a history of myocardial infarction?
Oosterom-Calo, R., Velde, S. J. T., Stut, W. J. J., Drory, Y., Brug, J., & Gerber, Y. (2016) · BMC Cardiovascular Disorders · doi:10.1186/s12872-016-0363-7 · Cited by 3
“More research is necessary to clarify the direction of causality, however, as there is also evidence that patients who are less active are more likely to develop HF [26].”
Background
Diabetes and the Cardiovascular System
Rigato, M., Fadini, G. P., & Avogaro, A. (2019) · Endocrinology · doi:10.1007/978-3-319-27316-7_6-3 · Cited by 3
Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies.
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Decreased plasma B-type natriuretic peptide levels in obesity are not explained by altered left ventricular hemodynamics
Fukuta, H., Ohte, N., Wakami, K., Goto, T., Tani, T., & Kimura, G. (2011) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2011.04.001 · Cited by 3
“Obesity is increasingly recognized as an independent risk factor for developing heart failure [2—4].”
Background
Is Left Ventricular Systolic Dysfunction a Risk Factor for Erectile Dysfunction?
Wehrberger, C., Rauchenwald, M., Spinka, R., Weber, H., Stephan Madersbacher, A., & Ponholzer, A. (2010) · Urology · doi:10.1016/j.urology.2009.11.040 · Cited by 3
Thiazolidinedione Therapy in a Patient with Diabetes After Cardiac Transplantation
Rizvi, A. A., & Bowman, M. A. (2002) · Endocrine Practice · doi:10.4158/ep.8.4.287 · Cited by 3
Obesity and Cardiac Disease
Alpert, M., & Parker, B. M. (2015) · Springer eBooks · doi:10.1007/978-3-319-12125-3_35-1 · Cited by 3
Hypertension and Heart Failure
Dorobanţu, M., Mancia, G., Grassi, G. M., & Voicu, V. A. (2019) · Updates in hypertension and cardiovascular protection · doi:10.1007/978-3-319-93320-7 · Cited by 3
Heart Failure as a Consequence of Ischemic Heart Disease
Flaherty, J. D., Bonow, R. O., & Gheorghiade, M. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-5895-3.10023-3 · Cited by 3
Hypertension as an Important Public Health Challenge
He, J., Kearney, P. M., & Whelton, P. K. (2003) · CRC Press eBooks · doi:10.1201/b14224-3 · Cited by 3
Self-citation
Insuficiencia cardíaca. Generalidades
Castillo, J. S.-P., & Sánchez, F. Á. L. (2017) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2017.06.001 · Cited by 3
Heart Failure as a Consequence of Ischemic Heart Disease
Felker, G. M., Mann, D. L., Flaherty, J. D., & Bonow, R. O. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-60987-6.00019-3 · Cited by 3
Sleep-disordered Breathing in Heart Failure: A Complex Bidirectional Pathophysiology
(2019) · Indian Journal of Sleep Medicine · doi:10.5005/jp-journals-10069-0045 · Cited by 3
Hypertension and heart failure: Diagnosis and management
Courville, K. A., & Ventura, H. O. (2006) · Current Hypertension Reports · doi:10.1007/s11906-006-0049-0 · Cited by 3
“Various predisposing factors may contribute to heart failure, including hypertension, coronary heart disease, diabetes mellitus, obesity, smoking, and valvular heart disease [ 11 ].”
Background
Should nonatopic asthma get equal attention?
Ownby, D. R., & Joseph, C. L. M. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.09.028 · Cited by 3
Should we be screening for myocardial hibernation in heart failure?
Lim, E. T. S., & Lahiri, A. (2004) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2004.01.005 · Cited by 3
The Prevalence of Thiamin Deficiency in Ambulatory Patients with Heart Failure
Azizi‐Namini, P. (2011) · TSpace (University of Toronto) · Cited by 3
Optimal Duration for Clopidogrel Suspension Prior to Coronary Artery Bypass Grafting
Ullah, W., Cheema, M. A., Haq, S., Abdullah, H. M. A., Ahmad, A., & Cohen, M. (2019) · Cardiology Research · doi:10.14740/cr842 · Cited by 2
“Moreover, greater than 60% of congestive heart failure (CHF) in the general US population can be attributed to CAD [16-20].”
Background
A combination of depression and decreased physical function further worsens the prognosis of patients with chronic cardiovascular disease
Kenya, O., Minako, Y.-T., Obara, S., Kariya, H., Kato, Y., Akinori, Y., Kamiya, K., Matsunaga, A., & Ako, J. (2020) · Journal of Cardiovascular Medicine and Cardiology · doi:10.17352/2455-2976.000115 · Cited by 2
“Patients with CVD develop heart failure symptoms at a high rate, leading to decreased peripheral blood fl ow, chronic infl ammation [27], decreased physical activity [33] and malnutrition [34], which may cause skeletal muscle disorder and decreased physical function [35].”
Avoidable Hospitalization for Heart Failure Among a Cohort of 18- to 64-Year-Old Italian Citizens and Immigrants: Results From the Italian Network for Longitudinal Metropolitan Studies
Zuanna, T. D., Cacciani, L., Barbieri, G., Batzella, E., Tona, F., Ferracin, E., Spadea, T., Girolamo, C. D., Caranci, N., Petrelli, A., et al. (2021) · Circulation Heart Failure · doi:10.1161/circheartfailure.120.008022 · Cited by 2
Sexual dimorphism in animal models of heart failure with preserved ejection fraction
Bauer, M., Gadkari, M., Yus, M. M., Santhanam, L., & Steppan, J. (2025) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00595.2024 · Cited by 2
Generation and evaluation of a novel PI3K-targeting gene therapy in the failing mouse heart and healthy sheep heart
Bass-Stringer, S., Donner, D. G., May, C. N., Matsumoto, A., Masterman, E. I., D'Elia, A. A., Chen, Y. C., Kiriazis, H., Luo, J., Chooi, R., et al. (2025) · Journal of Molecular and Cellular Cardiology Plus · doi:10.1016/j.jmccpl.2025.100478 · Cited by 2
“The importance of exercise as both a preventative measure and a treatment for HF has been well established and physical inactivity has been shown to be a primary risk factor in the development of HF [2 – 4].”
Comprehensive multiple risk factor control in cancer survivors to mitigate heart failure risk: insights from a prospective cohort study
Cai, Y.-W., Gao, J., Wu, M., Huang, Z.-G., Liao, G.-H., Zeng, C.-R., Liu, P., Chen, Y., Wang, J., & Zhang, H.-F. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf711 · Cited by 2
Effects of empagliflozin in patients at risk of heart failure: the empire prevent metabolic trial
Andersen, C. F., Larsen, J. H., Omar, M., Nouhravesh, N., Kistorp, C., Tuxen, C., Knop, F. K., Madsen, P. L., Forman, J. L., Davidovski, F. S., et al. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwag010 · Cited by 2
MitraClip and Transcatheter Aortic Valve Implantation (TAVI): State of the Art 2015
Candreva, A., Maisano, F., & Taramasso, M. (2015) · Current Heart Failure Reports · doi:10.1007/s11897-015-0275-3 · Cited by 2
“5 and 2 %, respectively [4].”
Herzinsuffizienz bei Adipositas und Metabolischem Syndrom
Fischer, M., & Baessler, A. (2014) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/s-0037-1618843 · Cited by 2
“Aus epidemiologischen Untersuchungen zur Ätiologie der Herzinsuffizienz lassen sich die wichtigsten Risikofaktoren für das Auftreten der Herzinsuffizienz ableiten: Bluthochdruck, koronare Herzkrankheit, Diabetes mellitus, Rauchen und Adipositas (3).”
Background
Transventricular Edge-to-Edge Repair of the Mitral Valve During Surgical Ventricular Restoration: Review of the Literature
Mihos, C. G., Santana, O., & Lamelas, J. (2012) · Journal of Cardiac Surgery · doi:10.1111/j.1540-8191.2011.01388.x · Cited by 2
Educational attainment and myocardial infarct-related congestive heart failure (The Determinants of Myocardial Infarction Onset Study)
Mukamal, K. J., Maclure, M., Muller, J. E., Sherwood, J. B., & Mittleman, M. A. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.02.017 · Cited by 2
Pharmacotherapy for comorbidities in chronic heart failure: a focus on hematinic deficiencies, diabetes mellitus and hyperkalemia
van der Wal, H. H., Beverborg, N. G., van Veldhuisen, D. J., Voors, A. A., & van der Meer, P. (2016) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2016.1197201 · Cited by 2
Molecular Changes in Heart Failure
Givens, R. C., & Schulze, P. C. (2017) · Springer eBooks · doi:10.1007/978-1-4471-4219-5_1 · Cited by 2
A Novel Non-Invasive Assessment of Cardiac Hemodynamics in Patients With Heart Failure and Atrial Fibrillation
Khraim, F., Alhamaydeh, M., Faramand, Z., Saba, S., & Al‐Zaiti, S. S. (2020) · Cardiology Research · doi:10.14740/cr1110 · Cited by 2
“ICG is a non-invasive technique to continuously assess cardiac hemodynamics by measuring the dynamic changes in total electrical conductivity of the thorax at any given time [6].”
Background
Section 5: Management of Asymptomatic Patients with Reduced Left Ventricular Ejection Fraction
Heart Failure Society of America (2010) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2010.05.014 · Cited by 2
Physical Activity/Exercise and Cardiovascular Disease
Emery, C. F., Truong, E. A. K., & Oliver, K. N. (2022) · Springer eBooks · doi:10.1007/978-0-387-85960-6_16 · Cited by 2
The intersection of heart failure and cancer in women: a review
Tyebally, S. M., Sia, C., Chen, D. H., Abiodun, A., Dalakoti, M., Chan, P. F., Koo, C. Y., & Tan, L. L. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1276141 · Cited by 2
The role of routine cardiac investigations before hyperbaric oxygen treatment
Brenna, C. T. A., Salvatori, M., Khan, S., Djaiani, G. N., Schiavo, S., & Katznelson, R. (2024) · Diving and Hyperbaric Medicine Journal · doi:10.28920/dhm54.2.120-126 · Cited by 2
Real-World Multicenter Registry to Determine Management and Quality of Care of Patients with Type 2 Diabetes, Hypertension, Heart Failure and/or Chronic Kidney Diseases in China (iCaReMe China)
Cai, X., Yang, W., Feng, B., Ji, Q., Liu, M., Li, Y., Tong, N., Sun, N., Zhao, M., & Ji, L. (2025) · Advances in Therapy · doi:10.1007/s12325-025-03114-w · Cited by 2
“In addition, results of several longitudinal observational studies of population-based cohorts with diabetes have shown a two-to fourfold increased risk of HF among patients with diabetes compared with those without [7, 8].”
Specific phenotypes of heart failure with preserved/reduced ejection fraction according to Body Mass Index
Matsushita, K., Harada, K., Jimba, T., Kohno, T., Nakano, H., Kitano, D., Takei, M., Kohsaka, S., Yoshino, H., Yamamoto, T., et al. (2025) · Minerva Cardiology and Angiology · doi:10.23736/s2724-5683.24.06633-x · Cited by 2
Prognostic Significance of Peripheral Monocyte Counts in Patients With Chronic Heart Failure
Nozuhara, A., Yamamoto, E., Komorita, T., Sueta, D., Fujisue, K., Oike, F., Ishii, M., Usuku, H., Hanatani, S., Araki, S., et al. (2025) · Circulation Reports · doi:10.1253/circrep.cr-25-0102 · Cited by 2
Risk of ischaemic and non-ischaemic heart failure in patients with systemic sclerosis: a population-based study
Bairkdar, M., Faxén, J., Arkema, E. V., Andersson, D. C., & Holmqvist, M. E. (2025) · Lara D. Veeken · doi:10.1093/rheumatology/keaf422 · Cited by 2
“It could be that HF in SSc is a manifestation secondary to SSc but it could also be a consequence of the known increased risk of myocardial infarction [6, 9, 10], one of the major risk factors for HF in the general population [11, 12].”
A diabetes mellitus prévia não agrava o prognóstico no primeiro ano após a transplantação cardíaca
António, N., Prieto, D., Providência, L. A., & Antunes, M. J. (2010) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) · Cited by 2
Management of Heart Failure in the Yaounde Military Hospital - Cameroon
Nloo, A. E., Kuate, L. M., Yayehd, K., Nkoké, C., Abissegue, Y., Bell, N., & Kingué, S. (2016) · HEALTH SCIENCES AND DISEASE · Cited by 2

Authors: He, J., Ogden, L. G., Bazzano, L. A., Vupputuri, S., Loria, C., & Whelton, P. K.
Affiliations: Tulane University (US)
Corresponding author: He, Jiang
ORCID: He, Jiang
Ogden, Lorraine G.
Bazzano, Lydia A.
Vupputuri, Suma
Loria, Catherine
Whelton, Paul K.
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)
DOI: 10.1001/archinte.161.7.996
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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Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study

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