A lifetime of prevention: the case of heart failure.

Abstract

It is widely acknowledged that heart failure (HF) is a growing public health and clinical problem and that, once diagnosed, the prognosis is grim. In this issue of Circulation , Lloyd-Jones and colleagues1 provide a lifetime perspective of HF from the Framingham Heart Study. Several messages are notable. First, the lifetime risk of developing HF at all ages is ≈20 percent in both men and women. This contrasts with the fact that short-term risks are substantially lower in younger individuals compared with older individuals (eg, 0.5% 5-year risk versus 21.0% lifelong risk, or a 40-fold difference in those 40 years of age; 1% versus 20%, or a 20-fold difference in those 60 years of age; and 8% versus 20%, or a 2.5-fold difference in those 80 years of age). This implies that for preventive strategies to be fully effective against HF, they may have to be implemented throughout the lifetime of an individual. See p 3068 Second, the analysis by Lloyd-Jones et al confirms the importance of hypertension and myocardial infarction, which together account for about three quarters of the population-attributable risk of HF. Both myocardial infarction2 and hypertension3 are largely preventable with currently known and available strategies …