A new NHANES analysis adds to the idea that heart failure might be more of a metabolic disease than just a cardiac problem, revealing that HF prevalence has remained constant over the last 35 years as ischemic causes decreased and metabolic factors increased.
- HF burden has increased roughly 43% in the U.S. since 1988, with crude prevalence rising from 2.1% to 3.0%, most likely due to an aging population.
- Traditional ischemic and hypertensive drivers of HF have historically dominated the conversation, but emerging metabolic factors may be reshaping the way we look at HF.
Examining over 30 years of data, the study analyzed 83.5k ambulatory participants (3k with HF history), finding that the age-adjusted HF prevalence remained stable over time with the crude increase entirely attributable to population aging.
However, among HF patients, metabolic risk factors showed serious increases…
- Obesity increased 27.9%.
- Impaired glucose homeostasis went up 20.6%.
- Diabetes jumped 15%.
- Chronic kidney disease also rose 13.7%.
Meanwhile traditional cardiovascular risk factors declined significantly…
- High cholesterol (-48.9%), elevated blood pressure (-31.5%), and MI history (-17.2%), which used to be seen as HF causes, all decreased.
- Cardiovascular mortality also dropped in HF patients (HR 0.30) with improved self-reported health and physical function.
While that second part might sound like good news, it really tells us that the nature of HF is what has changed over the last 35 years, with HFpEF now representing a much larger proportion of HF cases.
So what do we do with this information? This analysis, when taken in perspective to the recent JACC issue on the adipokine hypothesis, tells us that while we’ve gotten good at decreasing the structural causes of HF, we still haven’t addressed the metabolic ones.
- Fortunately, GLP-1s and other weight loss drugs have exploded in popularity and could help address this shift.
The Takeaway
As a 35-year longitudinal analysis, this study tells us that the population-level causes of HF have shifted dramatically from heart attacks and hypertension to obesity and diabetes. As long as we’re aware of that trend, we can shift our perspective on treating HF from reaction to prevention.
