The incidence of congestive heart failure (CHF) is expected to increase because of improved survival rates after myocardial infarction and an aging population. Lloyd-Jones and colleagues report data from the Framing-ham Heart Study on the estimated lifetime risk of developing CHF.

Study participants were followed from enrollment until their first CHF event, death, or until they reached 95 years of age. Risk was calculated for men and women at index ages of 40, 50, 60, 70, and 80 years, and according to blood pressure criteria. After age 40, the remaining lifetime risk of CHF was one in five for women and men at all index ages. Subgroup analysis showed that for patients who had not had a myocardial infarction, the risk was one in nine for men and one in six for women.

Hypertension is a risk factor for CHF and also increases the risk of myocardial infarction. Uncontrolled hypertension is an important contributor to the lifetime risk of CHF. In patients who have blood pressures greater than 160/100 mm Hg, the lifetime risk of developing CHF is doubled compared with patients who have blood pressures less than 140/90 mm Hg.

Compared with the lifetime risk for CHF of one in five, women 40 years of age have a one in eight lifetime risk of breast cancer and a one in three risk of coronary heart disease. Men at 40 years of age have a one in two risk of coronary heart disease.

The authors conclude that there should be more public health emphasis on the prevention of CHF, including efforts to control blood pressure and reduce the incidence of myocardial infarction through the management of other risk factors.

editor’s note:Because the average patient faces a 20 percent lifetime risk of developing CHF after 40 years of age, preventing CHF is a priority for family physicians. This study underscores the importance of vigilant control of hypertension. Family physicians will need to continue to refine their knowledge about treatment for what will be a growing population of patients with CHF.—c.c.