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Cited by 187Cardiovascular Health and Risk FactorsHeart Failure Treatment and ManagementCardiovascular Function and Risk Factors

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Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults

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Del Gobbo, Liana C., Kalantarian, Shadi, Imamura, Fumiaki, Lemaitre, Rozenn, Siscovick, David S., Psaty, Bruce M., Mozaffarian, Dariush·2015·JACC: Heart Failure
DOI 10.1016/j.jchf.2015.02.009PMC PMC4508377
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Abstract

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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Figure 1 Risk of Incident HF According to Number of Low-Risk Lifestyle Factors in Older Adults (n = 4,490) Low-risk lifestyle factors included walking pace ≥2 mph, leisure activity ≥850 kcal/week, no current smoking, ≥1 drink/week of alcohol, and a body mass index <30 kg/m2. Risk estimates were adjusted for age (years), sex (male vs. female), race (Caucasian vs. non-Caucasian), enrollment site (4 clinics), education (less than high school, high school, more than high school), annual income (<$25,000, $25,000 to $49,999, >$50,000). HF = heart failure; RR = risk ratio.
Figure 1 Risk of Incident HF According to Number of Low-Risk Lifestyle Factors in Older Adults (n = 4,490) Low-risk lifestyle factors included walking pace ≥2 mph, leisure activity ≥850 kcal/week, no current smoking, ≥1 drink/week of alcohol, and a body mass index <30 kg/m2. Risk estimates were adjusted for age (years), sex (male vs. female), race (Caucasian vs. non-Caucasian), enrollment site (4 clinics), education (less than high school, high school, more than high school), annual income (<$25,000, $25,000 to $49,999, >$50,000). HF = heart failure; RR = risk ratio.CC BY · PubMed Central
Figure 2 Risk of Incident HF for Low-Risk Lifestyle Factors in Major Subgroups of Older Adults (n = 4,490) Low-risk lifestyle factors included healthy diet pattern (upper 3 quintiles), walking pace ≥2 mph, leisure activity ≥850 kcal/week, no current smoking, ≥1 drink/week of alcohol intake, and a body mass index <30 kg/m2. Multivariate models for each lifestyle factor were adjusted for age (years), sex (male vs. female), race (Caucasian vs. non-Caucasian), enrollment site (4 clinics), education (less than high school, high school, more than high school), annual income (<$25,000, $25,000 to $49,999, >$50,000) and mutually adjusted for other lifestyle factors in the figure. None of the differences were significant after correcting for multiple comparisons. CHD = coronary heart disease; other abbreviations as in Figure 1.
Figure 2 Risk of Incident HF for Low-Risk Lifestyle Factors in Major Subgroups of Older Adults (n = 4,490) Low-risk lifestyle factors included healthy diet pattern (upper 3 quintiles), walking pace ≥2 mph, leisure activity ≥850 kcal/week, no current smoking, ≥1 drink/week of alcohol intake, and a body mass index <30 kg/m2. Multivariate models for each lifestyle factor were adjusted for age (years), sex (male vs. female), race (Caucasian vs. non-Caucasian), enrollment site (4 clinics), education (less than high school, high school, more than high school), annual income (<$25,000, $25,000 to $49,999, >$50,000) and mutually adjusted for other lifestyle factors in the figure. None of the differences were significant after correcting for multiple comparisons. CHD = coronary heart disease; other abbreviations as in Figure 1.CC BY · PubMed Central

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Metadata

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)
ORCID
Venue
JACC: Heart Failure
Publisher
Elsevier BV
Published
2015-07
Volume
3
Issue
7
Pages
520-528
ISSN
2213-1779 (ISSN-L)
DOI
10.1016/j.jchf.2015.02.009
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
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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