Obesity and diabetes by middle age tied to heart failure later on

man is unable to close his pants because of gaining weight (iStock)

People who reach middle age without developing high blood pressure, diabetes or obesity may have a lower risk of heart failure later in life, a recent study suggests.

Obesity, diabetes and hypertension can lead to structural changes in the heart that increase the stiffness of the muscle and reduce its ability to contract forcefully. These structural and functional changes in the muscle reduce the ability to circulate blood, which can lead to heart failure.

Compared to people with all three risk factors - high blood pressure, diabetes and obesity - adults who had none of these health problems by age 45 were 73 percent less likely to develop heart failure over the rest of their lifetime, the study found.

And when people reached 55 without any of these three risk factors, they were 83 percent less likely to develop heart failure than adults who did have these problems.

"Preventing the onset of obesity, hypertension and diabetes will substantially lower a person's risk for heart failure and substantially increase the average number of years they will live healthy," said senior study author Dr. John Wilkins of Northwestern University Feinberg School of Medicine in Chicago.

"The benefits of preventing the onset of the risk factors themselves often far exceeds the benefits experienced through treatment of the risk factors after they've developed," Wilkins added by email.

Approximately 5.7 million adults in the United States currently suffer from heart failure, researchers note in the Journal of the American College of Cardiology: Heart Failure.

This population faces a significantly reduced quality of life and higher mortality rates. Hypertension, obesity and diabetes are highly prevalent and preventable risk factors for heart failure, the authors write.

In an analysis of data on tens of thousands of U.S. men and women, researchers found 53 percent of them did not have diabetes, high blood pressure or obesity at age 45. Less than 1 percent did have all three risk factors at that age.

By age 55, about 44 percent of adults still didn't have any of the three risk factors for heart failure, and 2.6 percent had all three.

Researchers identified 1,677 cases of heart failure after age 45, and another 2,976 cases after age 55. They followed people through age 95 or death.

People who didn't have any of the three risk factors at 45 or 55 were significantly less likely to develop heart failure as they aged - this was true of men, women, white and black participants.

Men at age 45 years without any of the three risk factors lived an average of 10.6 years longer free of heart failure than those with all three, while women at age 45 without any of the three risk factors lived an average of 14.9 years longer without heart failure.

Of the three risk factors, diabetes had a particularly strong association with spending a shorter period free of heart failure. People without diabetes in middle age lived an average of 8.6 to 10.6 years longer without heart failure than those with the disease.

One limitation of the study is that people who joined at different points in time might have different generational risks of developing diabetes, obesity, high blood pressure or heart failure, the authors note. Researchers also lacked data on risk factors for heart failure earlier in life, or information on any lifestyle changes some participants might have made to improve their health before middle age.

Still, the study adds to a large body of evidence linking diabetes, high blood pressure and to a lesser extent obesity, to a higher risk of developing heart failure, said Dr. Mary Norine Walsh, medical director of heart failure and cardiac transplantation at St. Vincent Heart Center in Indianapolis, Indiana.

"All three of these conditions are risk factors for coronary heart disease, and people with coronary heart disease are prone to developing heart failure," Walsh, also president-elect of the American College of Cardiology, said by email.

"Keeping your weight under control pays off later in life, and monitoring your blood pressure and blood sugar with your physician is crucial," added Walsh, who wasn't involved in the study. "Avoiding all three of these conditions can add years to your life."