Heart failure risk factors: what raises the risk and what you can change

What heart failure is

Heart failure, also called congestive heart failure, develops when the heart does not pump enough blood for the body's needs. The heart may not fill up with enough blood, or it may be too weak to pump properly. The term does not mean that the heart has stopped, but heart failure is a serious condition that needs medical care (NHLBI). More than 6 million adults in the United States have it, according to the Centers for Disease Control and Prevention as quoted by the NHLBI (NHLBI).

Heart failure can start suddenly after a condition or injury damages the heart muscle, but in most cases it develops slowly from long-term medical conditions (MedlinePlus). Long-term heart failure is often caused by conditions that damage or overwork the heart. Sudden heart failure can be caused by an injury or infection that damages the heart, a heart attack, or a blood clot in the lung (NHLBI).

The conditions that lead to it

Most often, heart failure is caused by another medical condition that damages the heart (NHLBI). The NHLBI describes two main patterns on the left side of the heart, which is more often affected than the right (NHLBI):

• A weak heart (heart failure with reduced ejection fraction). Conditions that damage or weaken the heart muscle are the main cause. Coronary heart disease or a heart attack can keep the heart muscle from getting enough oxygen. Faulty heart valves, an irregular heartbeat, and heart diseases you are born with or inherit can also cause it (NHLBI).
• A stiff heart (heart failure with preserved ejection fraction). High blood pressure and other conditions that make the heart work harder are the main causes. Obesity and diabetes, which stiffen the heart's chambers, are causes too. Over time the heart muscle thickens to adapt, which makes it stiffer (NHLBI).

Over time, left-sided heart failure can lead to right-sided heart failure. Congenital heart defects, abnormal heart valves and lung diseases such as COPD can also damage the right side (NHLBI). MedlinePlus lists these conditions that can cause heart failure: arrhythmia, cardiomyopathy, congenital heart defects, coronary artery disease, endocarditis, heart attack, heart valve diseases, high blood pressure, a blood clot in the lung, diabetes, severe lung diseases such as COPD, and obesity (MedlinePlus).

Risk factors that raise the risk

Some risk factors you can control, such as lifestyle habits, but others, such as age, race or ethnicity, are out of your control. Your risk goes up if you have more than one of these (NHLBI):

• Age. Aging can weaken and stiffen the heart. People 65 or older have a higher risk, and older adults are also more likely to have other conditions that cause heart failure (NHLBI).
• Family history and genes. A family history of heart failure raises your risk. Certain gene changes can make heart tissue weaker or less flexible (NHLBI).
• High blood pressure and other heart or blood vessel conditions (NHLBI) (MedlinePlus).
• Obesity, diabetes, sleep apnea, chronic kidney disease, anemia, thyroid disease and iron overload (NHLBI).
• Atrial fibrillation, a common irregular heart rhythm, can also cause heart failure (NHLBI). See AFib risk factors.
• Serious lung disease, and infections such as HIV or SARS-CoV-2 (the virus that causes COVID-19) (NHLBI) (MedlinePlus).
• Cancer treatments such as radiation and chemotherapy, which can injure the heart (NHLBI).
• Lifestyle habits: an unhealthy diet, smoking, cocaine or other illegal drugs, heavy alcohol use, and lack of physical activity (NHLBI). MedlinePlus names eating foods high in fat, cholesterol and sodium (salt), and alcohol use disorder (MedlinePlus).
• Race. Black and African American people are more likely to have heart failure, often have more serious cases, and get it at a younger age (NHLBI). MedlinePlus adds that stigma, discrimination, income, education and region can also affect their risk (MedlinePlus).

Heart failure is common in both men and women, but men often develop it at a younger age. Women more often have the stiff-heart type and men the weak-heart type, and women often have worse symptoms (NHLBI).

Which ones you can change

Steps that lower the risk

The sooner you start, the better your chances of preventing or delaying heart failure. The NHLBI lists these steps (NHLBI):

• Adopt a heart-healthy lifestyle: choose heart-healthy foods, aim for a healthy weight, get regular physical activity, quit smoking and manage stress.
• Limit or avoid alcohol and do not use illegal drugs.
• Work with your provider to manage conditions that raise your risk, such as diabetes, high blood pressure and obesity.

MedlinePlus says the same in short: manage any health conditions that raise your risk, and make healthy changes in eating, exercise and other daily habits (MedlinePlus).

Early symptoms to report

Heart failure may not cause symptoms right away (NHLBI). With mild heart failure you may notice nothing except during hard physical work, and symptoms usually get worse as the heart grows weaker (NHLBI). One of the first symptoms you may notice is feeling short of breath after routine activities like climbing stairs. Later this may happen while getting dressed or walking across the room, and some people are short of breath while lying flat. Older adults who are not very active may not feel short of breath, but they may feel tired and confused (NHLBI).

Other symptoms include (NHLBI) (MedlinePlus):

• Fatigue or weakness, even after rest
• Coughing
• Swelling and weight gain from fluid in the ankles, feet, lower legs or belly, and swelling in the veins of the neck
• Trouble sleeping while lying flat
• Nausea and loss of appetite
• Needing to pee often

Tell your provider about these symptoms. If you already have heart failure, the NHLBI says weight gain, ankle swelling or increasing shortness of breath may mean fluid is building up. Symptoms can suddenly get worse, so ask your provider when to make an office visit and when to get emergency care (NHLBI).

General safety advice (not part of the source pages): chest pain, fainting or sudden, severe trouble breathing needs urgent care. Call 911.

Estimate your risk

The heart failure risk calculator uses the Framingham model to estimate a 4-year chance of heart failure for people aged 45 to 94 who already have high blood pressure, coronary heart disease or heart valve disease. For the 10-year chance of a first heart attack, stroke or heart failure, see the PREVENT heart risk calculator.

Common questions

Does heart failure mean the heart has stopped?

No. It means the heart does not pump enough blood for the body's needs. It is still a serious condition that needs medical care (NHLBI).

Can heart failure be cured?

There is no cure, but treatment such as healthy lifestyle changes, medicines, some devices and procedures can help many people have a higher quality of life (NHLBI).

Can high blood pressure cause heart failure?

Yes. High blood pressure and other conditions that make the heart work harder are the main causes of the stiff-heart type of heart failure (NHLBI).