title: The population burden of heart failure attributable to modifiable risk factors: the ARIC (Atherosclerosis Risk in Communities) study.
abstract: OBJECTIVE
  The goal of this study was to estimate the population burden of heart failure and the influence of modifiable risk factors.
  
  
  BACKGROUND
  Heart failure is a common, costly, and fatal disorder, yet few studies have evaluated the population-level influence of modifiable risk factors.
  
  
  METHODS
  From 14,709 ARIC (Atherosclerosis Risk in Communities) study participants, we estimated incidence rate differences (IRD) for the association between 5 modifiable risk factors (cigarette smoking, diabetes, elevated low-density lipoproteins, hypertension, and obesity) and heart failure. Potential impact fractions were used to measure expected changes in the heart failure incidence assuming achievement of a 5% proportional decrement in the prevalence of each risk factor.
  
  
  RESULTS
  Over an average of 17.6 years of follow-up, 1 in 3 African American and 1 in 4 Caucasian participants were hospitalized with heart failure, defined as the first hospitalization with International Classification of Diseases, Ninth Revision discharge codes of 428.x. Of the 5 modifiable risk factors, the largest IRD was observed for diabetes, which was associated with 1,058 (95% confidence interval [CI]: 787 to 1,329) and 660 (95% CI: 514 to 805) incident hospitalizations of heart failure/100,000 person-years among African-American and Caucasian participants, respectively. A 5% proportional reduction in the prevalence of diabetes would result in approximately 53 and 33 fewer incident heart failure hospitalizations per 100,000 person-years in African-American and Caucasian ARIC participants, respectively. When applied to U.S. populations, this reduction may prevent approximately 30,000 incident cases of heart failure annually.
  
  
  CONCLUSIONS
  Modest decrements in the prevalence of modifiable heart failure risk factors such as diabetes may substantially decrease the incidence of this major disease.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA. christy_avery@unc.edu
authors.forename: Christy L
authors.initials: CL
authors.lastname: Avery
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.forename: Christopher
authors.initials: C
authors.lastname: Baggett
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kucharska-Newton
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology