Special Populations Affected by Heart Failure

Anyone can develop heart failure (HF), whether you are young or old, male or female, or have a family history of heart disease.¹ Specific populations are at risk for certain kinds of heart conditions.

Children

Around 8 in every 1000 children are born with a congenital heart defect. This means some part of the heart is malformed and does not develop normally before birth.² There are at least 18 types of recognized congenital heart defects. With advances in medicine and technology, many of them can be surgically fixed, making way for normal development into adult life.²

Some babies are born with poorly functioning valves while others have a hole in the aorta or the chambers of the heart which can affect blood flow.³ Many of these defects, once considered life-threatening, can now be effectively treated if caught early. There are also severe malformations that result in more complex medical conditions and some infants don’t survive.

Congenital heart defects can increase the risk for developing other cardiac conditions including pulmonary hypertension, arrhythmias, endocarditis, heart failure, and coagulation problems.³ Most childhood heart defects are present at birth. Occasionally an infection can cause acquired heart disease. This includes conditions like Kawasaki disease and rheumatic fever. Genetic conditions and environmental exposures, like chemicals, drugs, and alcohol abuse during pregnancy can also contribute to the development of heart defects.³

Women

Nearly 25% of all female deaths are due to heart disease.⁴ There are some noted differences between men and women in the presentation, diagnosis, and treatment of heart disease.^4-5 From age 45 to 64, one in nine women will develop symptoms of some type of cardiovascular disease. After age 65, it will affect one in three women, according to the National Center for Health Statistics.⁵

Women are more likely to have atherosclerosis, heart failure, arrhythmias, and valvular disease. Atherosclerosis is a buildup of plaque in the arteries, causing the arteries to narrow and harden. This impairs blood flow and creates the risk of blood clots which can cause a sudden heart attack. Heart failure occurs when the heart doesn’t pump well enough to force the blood through the body supplying nutrients and oxygen to keep us alive.⁶ Irregular heartbeats, called arrhythmias, are more common in women but don’t always signify major problems. The four heart valves control blood flow in and out of the heart’s chambers. Disorders can be caused by birth defects, advancing age, or an infection. This can result in the heart to have to work harder sometimes leading to HF.⁶

Angina (chest pain), cardiac syndrome X (coronary artery spasms with arteries are that are not blocked) and broken heart syndrome (also known as stress-induced cardiomyopathy or takotsubo cardiomyopathy) are all conditions more prevalent in women. They can be temporary or stable conditions that rarely lead to a heart attack or death but require monitoring by your health care team.⁶

Men

Heart disease is the leading cause of death for men in the United States.⁷ Men tend to develop heart disease about 10 years earlier than women. There are a number of different factors including behavior and lifestyle that can influence this.^7-8 High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are three of the key risk factors for heart disease.⁷

Men with angry or hostile personalities or those with physical, and psychological issues associated with stress and anxietycan develop raised blood pressure and stress hormone levels. This can result in the restriction of blood flow to the heart.⁸

Metabolic syndrome is characterized by elevated blood sugar levels, high cholesterol, and increased belly fat. Along with diabetes, these can be risk factors for heart disease. Low testosterone levels are also increasingly thought to be cardiovascular and metabolic risk factors linked with the development of heart disease and type 2 diabetes.⁸

Erectile dysfunction (ED) may be one of the early warning signs for heart disease. Studies show that men in their 40s, without general risk factors for heart problems, but who have ED face an 80 percent risk of developing heart disease within 10 years.⁸ Talking to your doctor and being evaluated for ED, a vascular condition, can potentially identify additional risk factors that can be addressed before a more severe condition develops.⁸

Cancer survivors

Cancer survivors have a higher risk of developing heart disease than their siblings or the general population of people who have never had cancer.⁹ Effective treatments for cancer, including chemotherapy and radiation, have led to improved survival, but research shows that exposure to some of these therapies may increase the risk of developing cardiovascular disease.^10-11

Not only are people living longer in general, but medical advances have extended the life expectancy of many cancer patients.^9,12 Over 60% of cancer survivors are alive 5 years after diagnosis and 40% are alive 10 years later. This has led to a growing cohort of survivors who are at risk for treatment-related effects and comorbidities (other diseases).¹²

Oncologists, doctors who specialize in treating cancer, as well as other health care providers, need to consider the long-term impact of selected treatments.¹² This is especially important in people who already have or who are at high risk of developing heart disease prior to diagnosis and treatment.^10,12

Chemotherapy

Chemotherapy can damage the cardiovascular system by blocking new growth of blood vessels, increasing blood pressure, causing excess clotting, increasing inflammation, or disrupting the electrical system of the heart. This can lead to heart failure, coronary artery disease (CAD), hypertension, and rhythm problems like slow or irregular heartbeats.¹⁰

Radiation

Radiation treatment is an effective cancer-fighting tool but can also lead to the development of coronary and carotid artery disease.^10,11 This has been noted in survivors of non-Hodgkin lymphoma and breast cancer.¹¹ Radiation can damage the areas surrounding the cancer target. For example, people with breast cancer are at high risk for heart damage, particularly if the cancer was on the left side of the chest, where the heart sits. The radiation can damage heart valves, narrow the arteries, and even cause damage to the heart muscle.¹⁰

Preventive screenings and maintaining good health habits such as not smoking, getting sufficient exercise, and eating a healthy diet can help to reduce the risk of developing heart disease and other conditions both before and after treatment for cancer.^10,11