Risk factors for heart failure in the elderly: A prospective community-based study

PURPOSE: The risk factors for the development of heart failure are not clea rly defined, particularly for older adults. We undertook the current invest igation to examine the associations of traditional cardiovascular risk fact ors, comorbidity, and psychosocial factors with the risk of heart failure d uring 10 years of follow-up in a community-based elderly population. SUBJECTS AND METHODS: We evaluated 1,749 subjects, 65 years of age or older , free of heart failure, myocardial infarction, and angina at baseline, who were participating in the New Haven, Connecticut cohort of the Established Population for Epidemiologic Studies of the Elderly program. Cox proportio nal hazards regression models were used to determine risk ratios (RR) and 9 5% confidence intervals (CI). RESULTS: During 13,811 person-years of follow-up, 173 subjects developed in cident heart failure, as confirmed by chart review. Five factors were indep endent predictors of heart failure: male sex (RR = 1.7; CI, 1.3 to 2.4), ol der age (RR = 1.9; CI, 1.3 to 2.7 for age 75 to 84 years, RR = 3.0; CI, 1.7 to 5.5 for age 85 years and older, compared with less than or equal to 74 years), diabetes (RR = 2.9; CI, 2.0 to 4.3), pulse pressure greater than or equal to 70 mm Hg (RR = 2.3; CI, 1.3 to 4.3, compared with <50 mm Hg), and body mass index greater than or equal to 28 kg/m(2) (RR = 1.6; CI, 1.0 to 2.4, compared with <24 kg/ m(2)). Myocardial infarction occurred during fol low-up in 8% of the cohort and was also an important predictor of heart fai lure (RR = 21; CI, 15 to 31). CONCLUSIONS: Age and traditional cardiovascular risk factors are associated with the development of heart failure in the elderly. Preventive strategie s should focus on the management of diabetes, blood pressure, and weight, i n addition to the prevention and management of myocardial infarction. Am J Med. 1999;106:605-612. (C) 1999 by Excerpta Medica, Inc.