A nurse is reviewing a client's medical record. Which of the following findings places the client at increased risk for the development of heart failure? (Select all that apply)

Rationale: A. Osteoarthritis: Osteoarthritis primarily affects joints and mobility and does not directly increase the risk of developing heart failure. While limited activity could indirectly affect cardiovascular health, it is not considered a primary risk factor. B. Hypotension: Low blood pressure reduces cardiac workload and is generally not a risk factor for heart failure. In fact, chronic hypotension is less likely to contribute to the pathophysiology of heart failure compared with hypertension. C. Diabetes mellitus: Diabetes contributes to heart failure risk through mechanisms such as accelerated atherosclerosis, myocardial fibrosis, and microvascular damage. Hyperglycemia and insulin resistance increase the likelihood of developing cardiac dysfunction over time. D. Alcohol use disorder: Chronic excessive alcohol intake can lead to alcoholic cardiomyopathy, which weakens the heart muscle and increases the risk of developing heart failure. It also contributes to hypertension and arrhythmias, further elevating risk. E. Sleep apnea: Obstructive sleep apnea causes intermittent hypoxia, sympathetic nervous system activation, and increased cardiac workload. These changes increase the risk of developing hypertension, left ventricular hypertrophy, and eventually heart failure.