A research paper in the American Journal of Cardiology reports that during the course of our lifetimes, one in four black people and one in three white people will develop heart failure that can lead to sudden death or, more frequently, a progressive deterioration of heart function with worsening symptoms including shortness of breath, abdominal pain and swelling of the legs.
Often patients are unable to sleep flat and frequently wake up at night gasping for breath. Heart failure accounts for 40 percent of the half million deaths related to heart disease each year.
The common conditions that lead to heart failure are high blood pressure and coronary artery disease. Diabetes, cigarette smoking and being significantly overweight also increase the risk of heart problems.
Chronic lung disease, including emphysema and bronchitis, can damage the pulmonary arteries, which eventually cause the heart to fail.
More rarely, heart failure can occur because of damage to the heart valves or damage to the heart muscle from viruses, hormonal disorders (such as thyroid disease) or rare abnormalities of the heart muscle called cardiomyopathies.
Heart failure often occurs when the heart muscle becomes so weak that insufficient blood is pumped out with each heartbeat. This condition is referred to as systolic heart failure.
Alternately, the heart can fail because it becomes too rigid. After each beat, the heart relaxes and fills with blood. In this form of heart failure, referred to as diastolic dysfunction, less blood can enter the heart and be pumped out with each beat.
Over time, the abnormality becomes so severe that symptoms of heart failure develop.
Heart failure causes blood to back up in the lungs. Increased pressure in the lung veins results in the seepage of fluid into the tiny lung air pockets. This leads to a condition called pulmonary edema that frequently results in a sudden shortness of breath.
Blood also can back up in the abdomen and legs, causing liver enlargement, abdominal pain and marked swelling of the legs.
As the heart fails, hormonal changes occur that reduce the production of urine and result in retention of excessive fluid.
A sign of impending heart failure is a sudden increase in weight that may average as much as two or three pounds a day.
Treatment usually involves the use of diuretics (water pills) that get rid of excess fluid and, together with other medications, reverse most or all of the symptoms. With treatment, the patient may remain symptom-free for extended periods of time.
In many cases, the condition gradually worsens and eventually may contribute to the patient's death.
As with any other illness, the most effective treatment of heart failure is prevention. In a recent study published in the American Journal of Cardiology, the factors influencing heart failure were studied in a group of 14,700 black and white men and women between the ages of 45 and 64. They were followed for an average of 17.6 years.
Five major modifiable risk factors for heart failure were identified, including diabetes, elevated cholesterol, high blood pressure, smoking and obesity.
Much to their surprise, the most frequent risk factor leading to heart failure was diabetes. They noted that a reduction in the risk of diabetes by a few percentage points led to a substantially lower incidence of heart failure.
The benefits were far greater for blacks than whites, but the reason for the ethnic difference is not clear. They suggest the small reductions in the prevalence of diabetes has the potential to prevent 30,000 cases of heart failure annually.
Diabetes does not cause heart failure by itself. Rather, it makes all of the other risk factors, such as high levels of cholesterol and triglyceride, hypertension and obesity, much worse and more dangerous. Reducing the risk of diabetes reduces the effects of all of the other risk factors.
The prevalence of heart failure is truly staggering and remains an enormous epidemic that receives too little attention.
No question staying healthy, maintaining a reasonable weight, not smoking and treating hypercholesterolemia will together decrease the prevalence of adverse effects of diabetes that is first and foremost the greatest risk factor for heart failure.
Dr. David Lipschitz is the author of the book "Breaking The Rules Of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists visit the Creators Syndicate web page at www.creators.com. More information is available at: DrDavidHealth.com.
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