LAUSR

With an increasing life expectancy, the burden of heart failure (HF), in terms of social and healthcare costs, is of increasing concern. HF is a major public health problem and an important cause of mortality, morbidity and disability. Preventive strategies aimed at reducing the prevalence of HF are urgently required in order to preserve the sustainability of healthcare systems. HF is generally an insidious process, with a long-standing subclinical period, and despite the improvements in clinical HF management, little evidence regarding the long-term risk factors of HF is actually available. There is an urgent need to gather evidence on how to detect and tackle the long-term risk factors for HF, so as to delay or avoid the clinical manifestations of such an unfavourable condition. This relevant issue is addressed by Chen et al. in ‘The Study of men born in 1943’ presented in the current issue of the journal. A random sample of Swedish men born in 1943 were examined in 1993 (aged 50 years) and re-examined 21 years later in 2014 in order to determine the prevalence of cardiac dysfunction or HF and the potential risk factors in the past two decades. The study reflects the important burden of HF in elderly men, half of them having either cardiac dysfunction or clinical HF by the age of 71 years. A high body mass index (BMI) was the only independent risk factor for the development of either heart dysfunction or HF over a span of 21 years. In a previous issue, the authors reported, in successive cohorts of men aged 50 years, an increase of threefold in the prevalence of obesity (from 6% in 1963 to 19% in 2013), but a better control of other cardiovascular risk factors such as hypertension, dyslipidemia and tobacco use. In a setting where traditional cardiovascular risk factors are acceptably controlled, obesity in middle age happens to be the only independent predictor of HF. This result is challenging, taking into account the increasing prevalence of obesity throughout the world and its huge health, social and economic impact on individuals and societies. Overweight and obesity are increasing at a rapid rate in most of the EU member states, with estimates of 51.6% of the EU’s population (aged 18 years and over) overweight in 2014. According to EUROSTAT 2014, the age group of people ‘65–74’ had the highest prevalence of overweight (66%), followed by the age group ‘45–64’ (59.6%). Obesity increases the risk of chronic diseases such as certain cancers, type 2 diabetes and cardiovascular disease. Obesity is not only a risk factor for HF, but it is also a common comorbidity which complicates its diagnosis, management and outcomes. Delaying or preventing the development of overt HF should be a priority for any healthcare system. Despite the progress achieved in the detection and control of some cardiovascular risk factors, obesity and diabetes (both closely related) pose complex challenges that involve different health, social and political actors. Preventing obesity in middle age, even before the onset of other cardiovascular risk factors, could be an opportunity to reduce the prevalence of overt HF in the elderly. A larger span of HF prevention should therefore be considered, while a broader body of evidence is required to confirm the impact of such an action. From a general population perspective, the awareness of the impact of obesity as a risk factor for the future onset of HF is probably low. While the general population is more and more informed and concerned about the risk factors of atheroesclerotic disease, HF is often considered to be an age-related condition. From the public perspective, a better understanding of the factors involved in HF throughout life could facilitate the implementation of life-style and preventive interventions. HF is a likely horizon for the elderly and a tangible outcome for any of us. Health professionals together with health authorities and policymakers have an obligation to raise awareness of the potential means of preventing the onset of this disabling condition. While awaiting further evidence, it