Contribution of major lifestyle risk factors for incident heart failure in older adults: the Cardiovascular Health Study
Del, Gobbo Liana C
Siscovick, David S
Psaty, Bruce M
Journal of the American College of Cardiology: Heart Failure
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Del, G. L. C., Kalantarian, S., Imamura, F., Lemaitre, R., Siscovick, D. S., Psaty, B. M., & Mozaffarian, D. (2015). Contribution of major lifestyle risk factors for incident heart failure in older adults: the Cardiovascular Health Study. Journal of the American College of Cardiology: Heart Failure, 3 520-528. https://doi.org/10.1016/j.jchf.2015.02.009
Background: Heart failure (HF) incurs high morbidity, mortality and healthcare costs among adults ≥65years, the most rapidly growing segment of the US population. Objectives: The goal of this study was to determine the relative contribution of major lifestyle factors on the development of HF in older adults. Methods: We prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1380 cases) over 21.5years among 4490 men and women in the Cardiovascular Health Study, a community-based cohort of older adults. Lifestyle factors included four dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a biologic pattern, constructed using prior knowledge of cardiovascular disease dietary risk factors), four physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, walking distance), alcohol intake, smoking, and obesity. Results: No dietary pattern was associated with developing HF (p>0.05). Walking pace and leisure activity were associated with a 26% and 22% lower risk of HF, respectively [pace >3 vs. <2mph: HR:0.74(95%CI:0.63-0.86); leisure activity ≥845 vs. <845 kcal/week: HR:0.78(95%CI:0.69-0.87)]. Modest alcohol intake, maintaining a body mass index <30kg/m2, and not smoking were also independently associated with a lower risk of HF. Participants with ≥4 healthy lifestyle factors had a 45% [HR:0.55(95%CI: 0.42-0.74)] lower risk of HF. Heterogeneity by age, sex, cardiovascular disease, hypertension medication use, and diabetes was not observed. Conclusions: Among older US adults, physical activity, modest alcohol intake, avoiding obesity, and not smoking, but not dietary patterns, were associated with a lower risk of HF.
diet, nutrition, lifestyle, heart failure, sodium, physical activity
Role of the funding source: This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. Fumiaki Imamura was supported by Medical Research Council Unit Programme number MC_UU_125015/5.
External DOI: https://doi.org/10.1016/j.jchf.2015.02.009
This record's URL: https://www.repository.cam.ac.uk/handle/1810/248916
Creative Commons Attribution 4.0
Licence URL: http://creativecommons.org/licenses/by/4.0/
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