What is the most common cause of heart failure in developed countries?

Most Common Cause of Heart Failure in Developed Countries

Coronary artery disease (ischemic heart disease) is the most common cause of heart failure in developed countries, accounting for approximately two-thirds of cases of left ventricular systolic dysfunction. 1

Primary Etiology

• Coronary heart disease is the predominant cause in younger age groups where heart failure is more common in men, occurring in earlier decades 2
• Ischemic heart disease represents the principal etiology of heart failure in the Western world and well-developed countries 2, 3
• The European Society of Cardiology guidelines explicitly state that in younger age groups, heart failure is more common in men because the most common cause, coronary heart disease, occurs in earlier decades 2

Supporting Evidence from Multiple Guidelines

The 2008 ESC Guidelines provide clear epidemiological data showing that coronary artery disease has become the dominant cause as countries undergo socioeconomic development 2. This represents a shift from historical patterns where valvular disease (particularly rheumatic heart disease) was once a major cause but has become less prevalent 4.

Age and Gender Considerations

• In younger populations, coronary heart disease causes heart failure predominantly in men due to earlier onset of ischemic disease 2
• In elderly populations (mean age 75 years in developed countries), the prevalence becomes equal between sexes, though coronary disease remains the leading cause 2
• The overall prevalence of heart failure is increasing due to population aging and improved survival after coronary events 2

Secondary Causes

While coronary disease dominates, the remaining one-third of cases have nonischemic causes including 1:

• Hypertension (particularly important in African and African-American populations) 5
• Valvular heart disease
• Myocardial toxins
• Myocarditis
• Idiopathic dilated cardiomyopathy

Clinical Implications

• Better treatment of myocardial infarction means more patients survive with impaired myocardial function, paradoxically increasing the pool of patients who develop heart failure over time 4
• The success in postponing coronary events through effective primary and secondary prevention has contributed to the overall increase in heart failure prevalence 2
• Evaluation for ischemic heart disease is warranted in all patients with heart failure, especially if angina is present 6

Geographic Variations

This pattern is specific to developed countries. In developing nations, the epidemiology differs significantly 5:

• Rheumatic heart disease remains a major cause in Africa and Asia
• Chagas disease causes heart failure in South America
• However, as countries undergo epidemiological transition, the pattern increasingly resembles Western countries with coronary disease becoming predominant 5

Key Clinical Pitfall

Do not assume all heart failure is ischemic—approximately 30-35% of cases are nonischemic 1. A thorough evaluation including history of hypertension, valvular disease, alcohol use, cardiotoxic drug exposure, and family history of cardiomyopathy is essential to identify the specific etiology and guide appropriate treatment 7, 6.