Heart Failure Before Age 65: How Does it Happen?

As you get older, you are more likely to have heart failure — it’s the leading cause of hospitalization for people over age 65. But men and women under 65 also are at risk for developing heart failure. Why does that happen in younger people? And how can you prevent it?

It’s important to know that, despite its name, “heart failure” does not mean your heart has failed or stopped working. The term describes a medical condition in which the heart is not pumping enough blood to meet the body’s needs for blood and oxygen.

There are a number of factors that may make heart failure more likely, despite your age.

1. Cardiovascular risk factors
   People with one or more risk factors such as diabetes, obesity or hypertension are at a higher risk of developing heart failure. Hypertension, or uncontrolled high blood pressure, can increase the risk of heart failure two to three times.  Meanwhile,  physicians are seeing severe obesity — body mass index of 40 or higher — more frequently in younger patients admitted to hospital with heart failure symptoms, says cardiologist Emer Joyce, MD, PhD. Dr. Joyce recently completed a study on severe obesity and heart failure.
2. Heart muscle disease, such as dilated cardiomyopathy
   Damage to the heart muscle that causes the heart’s main chamber to enlarge and pump less efficiently is a frequent cause of heart failure in younger people. This condition, called dilated cardiomyopathy, has a number of causes. Most common are viral infections; drug or alcohol abuse; a genetic or inherited component; other medical illnesses such as thyroid disease; or medications used to treat cancer. Heart muscle disease caused by alcohol consumption may be reversible if the alcohol intake stops completely, Dr. Joyce says.
3. Medical conditions that accompany heart problems
   Any other primary heart problem can also create symptoms and signs of heart failure by interfering with the overall efficiency of the heart muscle, Dr. Joyce says. Most common among these are coronary artery disease, in which cholesterol deposits or plaque builds up in the arteries that supply the heart, which can cause blockages that lead to heart attacks. Also, heart rhythm problems such as atrial fibrillation and/or problems with the valves in the heart, such as leaking or narrowing, can create the symptoms and signs of heart failure.
4. Family history of heart disease
   Family history may be extremely important in determining risk for heart failure in younger people. An inherited cause for dilated cardiomyopathy is found in up to 35 percent of cases, and genetic causes may also be responsible for other types of heart muscle conditions, including hypertrophic (“thickened heart muscle”) cardiomyopathy and muscle disorders that primarily affect the right side of the heart, Dr. Joyce says.

Whether you think you have some risk factors or just want to stay as healthy as possible as you age, here are key steps you can take toward prevention, Dr. Joyce says.

Know your family history — Having two or more relatives who die of heart disease increases your risk, Dr. Joyce says. People who have heart failure symptoms and a family history of heart muscle disease or two or more relatives dying suddenly without explanation should consider genetic testing, she recommends. 

Get an annual physical exam — An annual checkup is critical because sometimes the symptoms of heart failure, such as fatigue, are easily overlooked, particularly in active younger people, Dr. Joyce says.

“Other symptoms of heart failure include shortness of breath with activity,  leg swelling and abdominal bloating or swelling,” Dr. Joyce says.

During your yearly visit, your doctor will review your history, blood tests, vital signs and EKG results to check the health of your heart and other organs. You doctor may order an echocardiogram or ultrasound of the heart if heart failure is suspected.

Monitor and modify your lifestyle risk factors — Track your BMI, or body mass index, rather than relying on a scale, Dr. Joyce says. BMI is a formula to measure height and weight. Using this formula, BMI of 18.5 to 24.9 is ideal, 25 to 29.9 is overweight and above 30 is obese.

Watch your alcohol intake, too, Dr. Joyce says. The Dietary Guidelines for Americans defines moderate drinking as one drink per day for women and up to two drinks per day for men.