How to avoid heart failure

About 10% of Americans will develop heart failure during their lifetimes, an incidence that rises substantially after age 65. But perhaps most concerning is that Americans are now dying from heart failure at a higher rate than 25 years ago, according to a study in the June 2024 issue of JAMA Cardiology.

"We are struggling to understand what has caused this change, which has made taking preventive measures against heart failure more important than ever," says cardiologist Dr. Mandeep R. Mehra, professor of medicine at Harvard Medical School and executive director of the Center for Advanced Heart Disease at Harvard-affiliated Brigham and Women's Hospital.

What is heart failure?

Contrary to its name, heart failure does not mean the heart has suddenly stopped, but rather that it does not pump blood as effectively as it should.

The pumping problem can affect the entire heart or just one side — left or right. Most cases occur because of left-sided issues: the left ventricle (the heart's largest chamber) is too weak or stiff to pump properly. Left-sided heart failure is classified into one of two main types depending on the heart's ejection fraction (EF) — the percentage of blood inside the left ventricle that gets pumped out with each contraction.

People with an EF of at least 50% have heart failure with preserved ejection fraction. Those with an EF of less than 40% have heart failure with reduced ejection fraction. People with an EF of 40% to 49% tend to have a mixed picture, but resemble those with reduced ejection fraction in their response to treatments.

Both types of left-sided heart failure have similar symptoms, such as fatigue or shortness of breath or wheezing with exertion or when lying flat, a persistent cough, and swelling in the legs and ankles. As swelling increases, people may experience sudden and significant weight gain.

"People may dismiss many of these symptoms, especially if they don't interfere with daily life, and associate them with general aging, but they must be checked out even if the symptoms appear minor or they come and go," says Dr. Mehra. Standard tests for suspected heart failure include blood tests, an electrocardiogram (ECG), a chest x-ray, and an echocardiogram (ultrasound of the heart).

Prevention is the best medicine

What can you do to reduce your risk for heart failure? "The best prevention is to address the top underlying contributors of heart failure, including high blood pressure, abnormal blood lipid levels, and weight gain," says Dr. Mehra. "Addressing these risk factors can also protect against developing coronary artery disease and diabetes, two of the main medical conditions that cause heart failure."

High blood pressure forces the heart to work harder to pump blood to the rest of the body. Over time, this can prompt the heart's left ventricle to thicken and enlarge. Abnormal blood lipid levels, especially high LDL (bad) cholesterol, can lead to a buildup of fatty deposits (plaque) in your coronary arteries, known as coronary artery disease. This, in turn, can cause persistent diminished blood supply to the heart muscle or a major heart attack, either of which can result in heart failure.

Extra weight increases the body's blood volume and makes the heart work harder to pump and circulate blood. Over time, this can lead to an enlarged heart muscle. Excess weight can also directly impair heart muscle function, which can further diminish its pumping action. Studies have found that a body mass index (BMI) of 30 and higher (classified as obese) is linked with a high risk for heart failure. "But even a BMI of 25 to 29.9, deemed overweight, still puts some people in danger," says Dr. Mehra.

Diet and exercise combo

Preventing heart failure always begins with the one-two punch of a heart-healthy diet and regular exercise. These steps may also help with weight loss.

Studies have shown that the plant-based Dietary Approaches to Stop Hypertension (DASH) diet helps lower blood pressure. The DASH diet emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts while minimizing salt, sugar, and red meat consumption. DASH and similar plant-based diets, like the Mediterranean diet, are also high in fiber, which helps reduce cholesterol. Fiber binds to cholesterol in the small intestine and prevents it from entering the bloodstream.

Moreover, a study published online Nov. 28, 2023, by the European Journal of Clinical Nutrition found that overweight adults who ate a plant-based diet consisting primarily of fruits, vegetables, grains, and legumes lost an average of about 13 pounds over 16 weeks.

Regarding exercise, Dr. Mehra says doing at least 30 minutes of daily aerobic activity is good for heart health and thus can help lower heart failure risk. Any kind of activity is helpful, such as running, swimming, cycling, pickleball, and walking. A study published Feb. 21, 2024, in JAMA Cardiology found that walking just 3,600 steps per day — about 1.5 miles — at a normal pace lowered the risk of heart failure by 26% compared to people who look fewer steps. "Staying consistently active is what's important," says Dr. Mehra.

He also advises having regular checks of your blood pressure and LDL cholesterol levels. If either is above goal, your doctor will likely recommend dietary changes, increased exercise, and medication if necessary, such as a diuretic, ACE inhibitor, or angiotensin-receptor blocker for blood pressure, and a statin to lower LDL cholesterol.

Image: © dotdotred/Getty Images