A pooled analysis of four cohort studies found that patients who did not have hypertension, obesity and diabetes by 45 to 55 years old had up to an 86 percent lower risk of developing heart failure during their lifetime.

Lead researcher Faraz S. Ahmad, MD, of the Quebec Heart and Lung Institute at Laval University in Canada, and colleagues published their results online in the Journal of the American College of Cardiology: Heart Failure on Nov. 28.

"This study adds to the understanding of how individual and aggregate risk factor levels, specifically in middle age, affect incident heart failure risk over the remaining lifespan," John T. Wilkins, MD, MS, a senior study author from Northwestern University, said in a news release. "These findings help reframe the heart failure prevention discussion by quantifying how the prevention of the development of these risk factors can lengthen healthy and overall survival and could vastly reduce the population burden of heart failure."

In the U.S., approximately 5.7 million adults have hypertension, according to the researchers. They added that the lifetime risk of heart failure ranges from 20 to 45 percent depending on sex and race.

The researchers evaluated data on participants from 45 to 95 years old who enrolled in the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry and Atherosclerosis Risk in Communities studies. They included patients with and without hypertension, obesity and diabetes.

They defined hypertension as patients receiving treatment or those with blood pressure of at least 140/90 mm Hg; obesity as a body mass index of at least 30 kg/m²; and diabetes as patients receiving treatment or those with a fasting glucose level of 126 mg/dL or greater.

At baseline, 53.2 percent of patients who were 45 years old and 43.7 percent of patients who were 55 years old were free of hypertension, obesity and diabetes. In addition, 0.98 percent and 2.6 percent of patients had all three risk factors, respectively.

During the follow-up period, there were 1,677 incident heart failure events among the patients who were 45 years old at baseline. Adults with no risk factors had a 73 percent to 85 percent lower risk of incident heart failure compared with those with all three risk factors.

Further, men who did not have hypertension, obesity or diabetes at age 45 lived an average of 34.7 years without incident heart failure, while women without those three risk factors lived an average of 38.0 years without incident heart failure. In addition, adults without hypertension, obesity or diabetes at age 45 lived an additional 3 to 15 years longer than those with one or more of the risk factors.

Men who had no risk factors at age 45 lived an average of 10.6 years longer free of heart failure than those with all three risk factors, while women who had no risk factors at age 45 lived an average of 14.9 years longer free of heart failure compared with those with all three risk factors.

There were similar trends for participants who were 55 years old at baseline and had no risk factors and for adults of different races and sexes.

“We show how the absence of these factors at ages 45 years and 55 years, compared to those with [hypertension], obesity, and [diabetes], significantly decreases risk for incident heart failure and substantially increases heart failure–free survival and overall survival,” the researchers wrote. “These data help reframe the heart failure prevention discussion by quantifying how primordial prevention—the prevention of the development of 3 heart failure risk factors—can lengthen healthy and overall survival and could vastly reduce the population burden of heart failure.”

The researchers cited a few limitations of their analysis, including that the studies had different definitions of incident heart failure and different enrollment and follow-up periods. They also mentioned the data did not account for the change in risk factors before or after 45 or 55 years old or the change in risk factors.

“The avoidance of [hypertension], obesity and [diabetes] by ages 45 years and 55 years may substantially prolong heart failure–free survival and reduce heart failure–related morbidity,” the researchers wrote. “These data underscore the importance of preventing the development of risk factors in mid-life for decreasing the public health impact of heart failure. Lastly, quantification of heart failure–free survival may be a novel, useful tool for risk communication to patients for the purposes of promoting cardiovascular health.”