Cardiologist Chiadi Ndumele discusses the importance of heart failure prevention and the robust Heart Failure Prevention program at Johns Hopkins.
mhm. Okay. Heart failure is a major clinical in public health challenge, affecting over six million adults in the United States and associated with enormous health care costs. Additionally, once heart failure develops its associated with fairly poor outcomes within approximately 50% 5 year mortality rate and a 90% 10 year mortality rate. As a result, there's increasing emphasis and interest within clinical practice guidelines on preventing heart failure before it starts. Our group is unique in that its focused on refining and applying strategies for heart failure, prevention in the community and in our clinical populations. There are several risk factors that are quite relevant to the development of heart failure, and fortunately, many of these risk factors are modifiable. Obesity is a major risk factor for the development of cardiac dysfunction and subsequent heart failure, and given the historic rates of obesity in the United States and globally, Currently, this represents a major public health challenge. While our prior work has shown that the relationship of obesity with atherosclerotic cardiovascular disease is largely explained by many of the co morbid conditions associated with obesity, like diabetes to slip idem AEA, hypertension and metabolic syndrome, what we've also found is that the relationship of obesity with heart failure is actually largely independent of these risk factors. Additionally, our strategies that we use to predict heart failure actually perform less well among individuals with excess weight likely reflecting nontraditional pathways, playing a large role in development of heart failure in those with obesity. So much of our work is focused on understanding this powerful link between obesity and the development of congestive heart failure. Additionally, there are several other uh, metabolic risk factors like diabetes and hypertension, that, when they develop, increased the risk of heart failure in those with obesity. However, they're striking variation where there's some individuals who are relatively protected and don't develop these metabolic risk factors while other individuals developed. Most of the risk factors associate with obesity. So a large part of our work is also a dedicated to understanding this variation in the development of metabolic risk factors among individuals with obesity and also uncovering the related pathways leading to heart failure risk. Socioeconomic status is another important factor to consider when thinking about heart failure risk. Low socioeconomic status is associated with a greater burden of obesity and with a greater likelihood of the development of many of the metabolic risk factors that are linked to obesity. In addition, our prior work has found that among individuals with metabolic risk factors like diabetes and metabolic syndrome, the Association of Socioeconomic Status with heart failure risk is actually magnified by the presence of metabolic risk factors. As a result, there is a need to incorporate socioeconomic status into our estimation of risk, particularly among those individuals with metabolic risk factors, and to consider the context of socioeconomic status when we're defining strategies for heart failure prevention in our clinical populations. The Heart Failure Prevention Program at Johns Hopkins has three major pillars. Research, clinical and education and outreach related to heart failure prevention. First, we're doing robust research related to understanding the various pathways related to heart failure, risk and refining strategies for both predicting and preventing heart failure, particularly heart failure that's related to obesity, metabolic syndrome, diabetes, socioeconomic status and uncle logic factors. Additionally, we're focused on the clinical component of heart failure prevention which is applying the best research and best evidence we have related to heart failure prevention to clinical populations, particularly those individuals who we've identified as having the highest risk for the development of heart failure. And finally we have a large focus on education and outreach so that we can help educate both our patients and providers on the importance of preventing heart failure before it even starts.
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