Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults
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OBJECTIVES: The goal of this study was to determine the relative contribution of major lifestyle factors on the development of heart failure (HF) in older adults. BACKGROUND: HF incurs high morbidity, mortality, and health care costs among adults ≥65 years of age, which is the most rapidly growing segment of the U.S. METHODS: We prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1,380 cases) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study, which is a community-based cohort of older adults. Lifestyle factors included 4 dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a Biologic pattern, which was constructed using previous knowledge of cardiovascular disease dietary risk factors), 4 physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, and 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 mph vs. <2 mph; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; leisure activity ≥845 kcal/week vs. <845 kcal/week; HR: 0.78; 95% CI: 0.69 to 0.87). Modest alcohol intake, maintaining a body mass index <30 kg/m(2), 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 to 0.74) lower risk of HF. Heterogeneity by age, sex, cardiovascular disease, hypertension medication use, and diabetes was not observed. CONCLUSIONS: Among older U.S. adults, physical activity, modest alcohol intake, avoiding obesity, and not smoking, but not dietary patterns, were associated with a lower risk of HF.
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Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.
“Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (271-274) (Fig. 10.6).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [271]
The Conclusions (page not specified) report that physical activity, not smoking, and avoiding obesity were associated with lower incident heart-failure risk in older adults. The Methods define incident heart failure using symptoms and clinical findings, supporting the reference to symptomatic disease. But this observational study does not establish that early prevention strategies or treatment of associated risk factors reduce incidence. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEarly primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.
“Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (268–271) (Fig. 10.5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [268]
The Conclusions (page unavailable) report that physical activity, not smoking, and avoiding obesity were associated with lower incident heart-failure risk in older adults. The Methods confirm that cases had symptoms, but this observational study did not test whether early prevention or treatment of risk factors reduces heart failure. It also found no association between overall dietary patterns and lower heart-failure risk. (LLM, conf=0.88)
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- Authors
- Del Gobbo, L. C., Kalantarian, S., Imamura, F., Lemaitre, R., Siscovick, D. S., Psaty, B. M., & Mozaffarian, D.
- Affiliations
- Harvard University (US)
- University of Cambridge (GB)
- University of Washington (US)
- Group Health Cooperative (US)
- Brigham and Women's Hospital (US)
- Venue
- JACC: Heart Failure
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 3
- Issue
- 7
- Pages
- 520-528
- ISSN
- 2213-1779 (ISSN-L)
- PMC
- PMC4508377
- OpenAlex
- W844777641
- Cited by
- 186
- References
- 33
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 20 · 2023: 13 · 2022: 17 · 2021: 21 · 2020: 23 · 2019: 19 · 2018: 14 · 2017: 12 · 2016: 17 · 2015: 7
- FWCI
- 12.13
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Funders
- National Heart, Lung, and Blood Institute (HL080295)
- National Institute on Aging (AG023629)
- Medical Research Council Unit Programme (MC_UU_125015/5)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure, older adults, lifestyle risk factors, physical activity, walking speed, leisure-time physical activity, alcohol consumption, smoking, obesity, dietary habits, healthy lifestyle, incident heart failure risk
- MeSH terms
- Aged, Alcohol Drinking, Diet, Female, Heart Failure, Humans, Male, Motor Activity, Obesity, Prospective Studies, Risk Factors, Smoking, United States, Cohort Studies, Incidence, Proportional Hazards Models, Sedentary Behavior
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