What causes heart failure?
Heart failure can be caused by any disease or condition that damages the heart muscle directly or makes the heart work harder to pump out blood. The heart muscle may stretch too much and become too weak to pump efficiently, or it may thicken too much and become too stiff to relax and fill with enough blood. A wide range of conditions can damage the heart muscle, from long-term wear and tear on the heart to alcohol abuse and viral infections. Most cases of heart failure can be attributed to one or more of the following conditions.
High Blood Pressure
High blood pressure is a leading cause of heart failure in women, especially in African-American women. High blood pressure forces the heart to work harder to pump out blood against the increased pressure in the blood vessels. Over time, the increased workload can damage the heart muscle, causing it to become weak or stiff. Women with high blood pressure have 3 times the risk of developing heart failure compared to women without high blood pressure.5
Women with heart failure are more likely than men to have high blood pressure.6, 7 The Framingham Heart Study found that high blood pressure accounted for nearly 60% of heart failure cases in women, compared with about 40% in men.1, 5 Click here for more information on high blood pressure and heart failure.
Coronary Artery Disease
Coronary artery disease (CAD) is a major cause of heart failure in women. When the coronary arteries along the surface of the heart become blocked or narrowed with plaque, the heart doesn't receive enough blood and oxygen, eventually causing the muscle to weaken. Heart attacks caused by blocked arteries can destroy heart muscle and put you at high risk for developing heart failure. Although CAD and heart attacks are a less common cause of heart failure in women than in men,7 women who do suffer a heart attack have a higher risk than men of developing heart failure within 5 years: 37% of women compared with 29% of men.3 Click here for more information on how CAD increases your risk of developing heart failure.
Diabetes is a significant cause of heart failure, increasing the risk of developing heart failure 5-fold in women—almost twice the risk increase seen in diabetic men.8 Diabetes itself can directly damage the heart muscle, or it can accelerate the development of high blood pressure, CAD, and heart attacks, all of which can damage the heart.8 Click here for more information on diabetes and heart failure.
Obesity directly increases your risk of developing heart failure by making your heart work harder to supply blood because of the extra weight. Obesity also contributes to other heart failure-related conditions such as high blood pressure and diabetes.9 Women with heart failure are more likely than men to be obese.10 The Framingham Heart Study found that each 1-point increase in body mass index (BMI) was associated with a 7% increase in the risk of heart failure in women and a 5% increase in men.11 Click here for more information on how obesity increases your risk of developing heart failure.
Heart Muscle Disease ( Cardiomyopathy)
Heart failure can also develop as a result of heart muscle disease (cardiomyopathy) that causes the muscle of the pumping chambers to enlarge by stretching or thickening, damaging the heart's ability to pump blood efficiently to the rest of the body. Heart muscle disease can be caused by viral infections (such as viruses causing a common cold), using substances toxic to the heart (for example, alcohol and illegal drugs such as cocaine), or certain chemotherapy drugs. Some cases of heart muscle disease are caused by an inherited genetic defect; in many others, the cause is unknown.
Although rare, one cause of heart failure unique to women is peripartum cardiomyopathy: a weakening of the heart muscle developing in the last 3 months of pregnancy or in the first 5 months after delivery.12 Most cases occur in women older than 30, especially in African-American women. Although it is not known what causes this condition, risk factors include multiple pregnancies, multiple births (for example, twins), high blood pressure developed during pregnancy, and preeclampsia during pregnancy.13 Click here for more information on pregnancy and heart failure.
Other causes of heart failure include heart valve disease, irregular heartbeats or arrhythmias (such as atrial fibrillation), or heart defects present at birth (congenital heart disease), all of which cause the heart to work harder to pump blood.
Who is at risk for heart failure?
Risk Factors You Can't Change
Age: Although heart failure can happen at any age, aging increases the risk dramatically because as we age and our muscles weaken, so does our heart. About 70% of women with heart failure are over the age of 50, and heart failure is the number one reason for hospital visits for people who are 65 years or older.14, 15 Click here for more information on how aging affects your heart failure risk.
Gender: Although men have a higher risk than women of developing heart failure, more women have the condition in actual numbers because more women than men live into their 70s and 80s, when heart failure is most common. The underlying causes of heart failure vary between women and men. Coronary artery disease (CAD) is a less widespread cause of heart failure in women than it is in men, while women with heart failure are more likely than men to have high blood pressure.7 When a woman develops CAD, however, she is much more likely to develop heart failure than if she had high blood pressure, a more widespread disease.16
Race: African-American women are more likely to suffer from heart failure than women of other races or ethnicities. This may be because African Americans are more likely to have high blood pressure,17 one of the main risk factors for heart failure. One study found that high blood pressure was the main cause of heart failure in 32% of African Americans, compared with 4% in whites.18 Click here for more information on how your race or ethnicity can affect your heart failure risk.
Risk Factors You Can Change
There are other risk factors for heart failure that are completely or partly in your control, including certain conditions—such as high blood pressure, CAD, and diabetes—and lifestyle choices, such as smoking, not exercising, and not eating healthy. All of these can weaken or stiffen the heart and damage its pumping ability. Click on any of the conditions below to find out more about how they put you at risk for heart failure and what you can do about it.
Can heart failure be prevented?
Yes. The best way to prevent heart failure is to have a healthy lifestyle. Eat a healthy diet low in sodium and rich in fruits, vegetables, and whole grains. Exercise regularly, at least 30 minutes most days of the week. If you are overweight or obese, lose weight. If you smoke, stop. Don't abuse alcohol and don't use illegal drugs.
It is also critical to know your heart failure risk and control your risk factors, such as high blood pressure, coronary artery disease, diabetes, and obesity. If you are at risk for developing heart failure (AHA/ACC Stage A), you can take medications—in addition to the lifestyle changes mentioned above—to control your risk factors and reduce your risk of developing heart failure.
If you have had a heart attack but have no heart failure symptoms (AHA/ACC Stage B), you are at a considerably higher risk of developing heart failure. However, you can still reduce your risk of heart failure. Talk to your doctor about medications ( beta-blockers, ACE inhibitors, or ARBs) or other treatments (implantable defibrillator if you have atrial fibrillation, angioplasty or stents if you have had a heard attack) that can help reduce your risk.