Author + information
- Received April 18, 2018
- Revision received June 6, 2018
- Accepted June 14, 2018
- Published online September 5, 2018.
- Michael J. LaMonte, PhD, MPHa,∗ (, )
- JoAnn E. Manson, MD, DrPHb,
- Andrea K. Chomistek, ScDc,
- Joseph C. Larson, MSd,
- Cora E. Lewis, MD, MSPHe,
- Jennifer W. Bea, PhDf,
- Karen C. Johnson, MD, MPHg,
- Wenjun Li, PhDh,
- Liviu Klein, MDi,
- Andrea Z. LaCroix, PhDj,
- Marcia L. Stefanick, PhDk,l,
- Jean Wactawski-Wende, PhDa and
- Charles B. Eaton, MD, MSm,n
- aDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
- bDivision of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- cDepartment of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
- dFred Hutchinson Cancer Research Center, Seattle, Washington
- eDepartment of Preventive Medicine, University of Alabama at Birmingham Medical School, Birmingham, Alaska
- fDepartments of Medicine and Nutritional Sciences, University of Arizona Cancer Center, Tucson, Arizona
- gDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- hDepartment of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- iDepartment of Cardiology, University of San Francisco School of Medicine, San Francisco, California
- jDepartment of Epidemiology, University of California, San Diego, California
- kDepartment of Medicine, Stanford University Medical School, Stanford, California
- lDepartment of Gynecology Obstetrics, Stanford University Medical School, Stanford, California
- mDepartment of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- nDepartment of Epidemiology, Brown University School of Public Health, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Providence, Rhode Island
- ↵∗Address for correspondence:
Dr. Michael J. LaMonte, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, 3435 Main Street, Buffalo, New York 14214.
Objectives This study prospectively examined physical activity levels and the incidence of heart failure (HF) in 137,303 women, ages 50 to 79 years, and examined a subset of 35,272 women who, it was determined, had HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF).
Background The role of physical activity in HF risk among older women is unclear, particularly for incidence of HFpEF or HFrEF.
Methods Women were free of HF and reported ability to walk at least 1 block without assistance at baseline. Recreational physical activity was self-reported. The study documented 2,523 cases of total HF, and 451 and 734 cases of HFrEF and HFpEF, respectively, during a mean 14-year follow-up.
Results After controlling for age, race, education, income, smoking, alcohol, hormone therapy, and hysterectomy status, compared with women who reported no physical activity (referent group), inverse associations were observed across incremental tertiles of total physical activity for overall HF (hazard ratio [HR]: Tertile 1 = 0.89, Tertile 2 = 0.74, Tertile 3 = 0.65; trend p < 0.001), HFpEF (HR: 0.93, 0.70, 0.68; p < 0.001), and HFrEF (HR: 0.81, 0.59, 0.68; p = 0.01). Additional controlling for potential mediating factors included attenuated time-varying coronary heart disease (CHD) (nonfatal myocardial infarction, coronary revascularization) diagnosis but did not eliminate the inverse associations. Walking, the most common form of physical activity in older women, was also inversely associated with HF risks (overall: 1.00, 0.98, 0.93, 0.72; p < 0.001; HFpEF: 1.00, 0.98, 0.87, 0.67; p < 0.001; HFrEF: 1.00, 0.75, 0.78, 0.67; p = 0.01). Associations between total physical activity and HF were consistent across subgroups, defined by age, body mass index, diabetes, hypertension, physical function, and CHD diagnosis. Analysis of physical activity as a time-varying exposure yielded findings comparable to those of baseline physical activity.
Conclusions Higher levels of recreational physical activity, including walking, are associated with significantly reduced HF risk in community-dwelling older women.
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 18, 2018.
- Revision received June 6, 2018.
- Accepted June 14, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.