The incidence of heart failure has decreased over the last 50 years in women but not in men, according to an analysis of data from the Framingham Heart Study published in the October 31st issue of the New England Journal of Medicine. The long-term community study shows that survival has improved in both sexes.

The Framingham Heart Study began in 1948 and continues to follow the development of various forms of heart disease in 5,209 volunteers from that U.S. community. A second generation, which included 5,124 of the original participants' adult children and their spouses, was recruited in 1971.

The authors noted that overall improvement in survival after onset of heart failure was roughly 12 percent per decade for both men and women.

The findings on incidence were particularly interesting because they differed for men and women. When incidence rates for men were compared, the rate in the most recent period (1990 through 1999) had remained virtually the same since the original time period (1950 through 1969). In contrast, incidence among women had decreased by 31 percent to 40 percent over the same time frame.

An accompanying editorial by Margaret Redfield, M.D., places the new findings in context, highlighting the need for patients to receive the medications --- beta-blockers, angiotensin-converting enzyme inhibitors, and aldosterone antagonists -- that have been proven effective as treatments.

"The study found that heart failure survival was essentially unchanged from the 1950s through the 1980s," noted Dr. Redfield. "About 30 percent of heart failure patients died within one year, and 60 percent within five years. In the 1990s, however, short- and long-term mortality declined to 25 percent and 50 percent respectively."

"This study has implications for people of all ages," said Dr. Redfield. "A person who reaches age 40 has a 20 percent chance of developing heart failure in his or her lifetime. Reducing heart disease risk factors is essential, and it is never too early to start regular physical activity, avoid tobacco exposure, and keep blood pressure and lipids under control. Obesity is an American epidemic that is linked to an increase in type II diabetes, and both obesity and diabetes raise the risk of heart disease and, eventually, heart failure."