Author + information
- Received December 23, 2014
- Revision received February 12, 2015
- Accepted February 14, 2015
- Published online July 1, 2015.
- Liana C. Del Gobbo, PhD∗∗ (, )
- Shadi Kalantarian, MD, MPH†,
- Fumiaki Imamura, PhD‡,
- Rozenn Lemaitre, PhD§,‖,
- David S. Siscovick, MD, MPH§,
- Bruce M. Psaty, MD, MPH, PhD§,‖,¶ and
- Dariush Mozaffarian, MD, DrPH†,#
- ∗Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
- †Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
- ‡Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- §Department of Medicine, University of Washington, Seattle, Washington
- ‖Department of Epidemiology, University of Washington, Seattle, Washington
- ¶Group Health Research Institute, Group Health Cooperative, Seattle, Washington
- #Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Reprints requests and correspondence:
Dr. Liana Del Gobbo, Tufts University, 655 Huntington Avenue, Building 2-349, Boston, Massachusetts 02115.
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. population.
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/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 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.
Drs. Del Gobbo and Mozaffarian are currently affiliated with the Friedman School of Nutrition, Science & Policy, Tufts University, Boston, Massachusetts. This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contributions 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 Cardiovascular Health Study investigators and institutions can be found at: https://CHS-NHLBI.org. Dr. Imamura was supported by Medical Research Council Unit Programme number MC_UU_125015/5. The supporting agencies had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, and approval of the paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Dr. Psaty has served as a Data and Safety Monitoring Board member for a clinical trial of a device funded by the manufacturer (Zoll LifeCor); and on the Steering Committee of Yale Open Data Access Project funded by Johnson & Johnson. Dr. Mozaffarian has received ad hoc honoraria from Bunge, Pollock Institute, and Quaker Oats; has been an ad hoc consultant for Foodminds, Nutrition Impact, Amarin, AstraZeneca, Winston and Strawn LLP, and Life Sciences Research Organization; has been a member of the Unilever North America Scientific Advisory Board; and received chapter royalties from UpToDate. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 23, 2014.
- Revision received February 12, 2015.
- Accepted February 14, 2015.
- 2015 American College of Cardiology Foundation