Cardiomyopathy risk factors: who is more likely

What cardiomyopathy is

The word cardiomyopathy means "heart muscle disease." Depending on the type, the heart muscle may become thicker, stiffer or larger than normal. These changes weaken the heart and may cause an irregular heartbeat, heart failure, or a life-threatening event such as cardiac arrest (NHLBI). MedlinePlus adds that some people live long, healthy lives with cardiomyopathy and some do not even realize they have it (MedlinePlus).

Cardiomyopathy can affect people of any sex, race or age, and there are several types with many causes and risk factors. Many times, the cause is not known (NHLBI). Cardiomyopathy is one of the conditions that can lead to heart failure; see heart failure risk factors for that wider picture.

Inherited, acquired or congenital

NHLBI sorts the causes into three groups (NHLBI):

• Inherited: a parent passed on a gene change that keeps the heart from developing properly. Hypertrophic and arrhythmogenic cardiomyopathy are often inherited.
• Acquired: you were not born with it but developed it because of another disease or condition that damages the heart.
• Congenital: present at birth, either as cardiomyopathy itself or as a result of a congenital heart defect. It may come from health conditions of the mother or the developing baby that are not inherited.

MedlinePlus says heart attacks, high blood pressure, infections and other diseases can all cause cardiomyopathy, and some types run in families (MedlinePlus).

Risk factors you can change

NHLBI says lifestyle habits can raise the risk, and names these steps to lower it (NHLBI):

• Alcohol. Heavy drinking is linked with cardiomyopathy. NHLBI defines heavy drinking as more than 7 drinks a week for women and more than 14 a week for men, and says even moderate drinking for more than 10 years is linked with it. See alcohol and cancer risk for other effects of drinking.
• Drugs. Cocaine, amphetamines and anabolic-androgenic steroids (unless prescribed) can damage the heart muscle. NHLBI notes some evidence that marijuana can raise the risk of takotsubo cardiomyopathy.
• Extreme stress. It can raise the risk of takotsubo cardiomyopathy, also called broken heart syndrome, especially with other risk factors.
• Infections. They raise the risk of septic cardiomyopathy and other heart damage, so NHLBI advises keeping up to date on vaccines.

Risk factors you cannot control

NHLBI lists these (NHLBI):

• Age, by type. Septic cardiomyopathy is more common in newborns, arrhythmogenic cardiomyopathy in teens and young adults, dilated cardiomyopathy in adults aged 20 to 60, hypertrophic cardiomyopathy in people in their 30s, and takotsubo cardiomyopathy in women after menopause.
• Family history of cardiomyopathy or other heart conditions.
• Race. Black people have a risk of dilated cardiomyopathy nearly three times that of White people (NHLBI). NHLBI also says transthyretin amyloid cardiomyopathy, a type of restrictive cardiomyopathy, is more common in Black men (NHLBI).
• Chemotherapy or radiation treatment for cancer.
• Other medical conditions: pregnancy; diseases that affect how well muscles work, such as Duchenne muscular dystrophy; diseases that cause substances to build up in the heart, such as sarcoidosis or amyloidosis; heart inflammation; infections such as viral hepatitis, HIV and COVID-19; obesity, diabetes or other metabolic problems; sepsis; and thyroid disease or other hormone problems.

The main types and who they affect

All types weaken the heart muscle, some are rarer than others, and some are temporary and get better with time (NHLBI). In NHLBI's descriptions (NHLBI):

• Dilated: a common type in which the lower chambers of the heart (ventricles) weaken and get larger.
• Hypertrophic: the heart muscle becomes larger and thicker than normal. It is commonly inherited, and first-degree relatives should be alerted and screened. Scientists estimate only 1 in 5 people who have it get diagnosed, mainly because they have no symptoms (NHLBI). NHLBI says young adults, even athletes, are at risk for this type (NHLBI).
• Arrhythmogenic: rare; fatty or scarred tissue replaces normal muscle in the right ventricle. It usually affects teens or young adults and raises the risk of cardiac arrest.
• Peripartum: rare but serious; it most often develops late in pregnancy or within a few months after giving birth.
• Restrictive: rare; the ventricles stiffen and cannot fill with enough blood.
• Septic: between 1 and 7 of every 10 people who get sepsis develop it, and it usually goes away within 10 days if the person recovers from sepsis.
• Takotsubo (broken heart syndrome): rare; extreme emotional or physical stress makes the heart muscle stop working properly. It affects more women than men and usually recovers in 3 to 4 weeks with medicine.

When it runs in families

NHLBI says your provider may screen you for cardiomyopathy if a close relative has it or has had another serious heart condition, and will ask whether anyone in your family has died suddenly. Genetic testing matters if you or a blood relative has cardiomyopathy or another heart condition that runs in families, and a genetic counselor can help (NHLBI). There is no way to prevent inherited cardiomyopathy, but a genetic counselor can tell you about the chance of passing a gene on to your children (NHLBI).

Symptoms

Some people with cardiomyopathy never have symptoms, and others do not have them until the condition gets worse. Common symptoms NHLBI lists are shortness of breath (especially after a large meal), chest pain (especially after activity or a large meal), tiredness even after resting, dizziness and fainting, irregular heartbeats, a heart murmur and palpitations. Babies and young children may instead have vomiting, diarrhea, problems eating or breathing, fussiness, fainting, swelling, extreme sleepiness or poor growth (NHLBI).

Lowering the risk

NHLBI says you may be able to prevent acquired cardiomyopathy with heart-healthy changes: heart-healthy foods, physical activity, a healthy weight, quitting smoking, quality sleep and managing stress, along with avoiding too much alcohol and drugs such as cocaine. Treating conditions that can cause cardiomyopathy and staying up to date on vaccines also help, and good pre-pregnancy and prenatal care can lower the chance of a baby being born with congenital cardiomyopathy (NHLBI).

Cardiomyopathy is one of the heart problems NHLBI lists as raising the risk of cardiac arrest; see sudden cardiac arrest risk factors (NHLBI).

Common questions

Is cardiomyopathy genetic?

Sometimes. NHLBI says hypertrophic and arrhythmogenic cardiomyopathy are often inherited, while acquired cardiomyopathy develops from another disease or condition (NHLBI). Many times the cause is not known (NHLBI).

Can young, fit people get cardiomyopathy?

Yes. NHLBI says young adults, even athletes, are at risk for hypertrophic cardiomyopathy (NHLBI), and that arrhythmogenic cardiomyopathy usually affects teens or young adults (NHLBI).

Can drinking alcohol cause cardiomyopathy?

NHLBI says heavy drinking is linked with cardiomyopathy, and even moderate drinking for more than 10 years is linked with it (NHLBI).