Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults: The Cardiovascular Health Study

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.

Keywords: diet; heart failure; lifestyle; nutrition; physical activity; sodium.

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 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.