Healthy lifestyle lowered HF risk in postmenopausal women

In postmenopausal women, an increasingly healthy lifestyle was associated with decreasing risk for HF, regardless of prior CV conditions.

Researchers for a new study evaluated the effect of a combination of lifestyle factors on incident HF and whether weighting the factors had any additional impact. Golareh Agha, PhD, from the department of environmental health at Harvard School of Public Health, and colleagues analyzed 84,537 postmenopausal women from the Women’s Health Initiative observational study who did not report HF at baseline.

Agha and colleagues developed a healthy lifestyle score in which women received one point for each of four healthy criterion met: high score on the Alternative Healthy Eating Index; physically active, defined as at least 150 minutes of moderate physical activity or at least 75 minutes of vigorous physical activity per week; no current smoking; and BMI of 18.5 kg/m² to <25 kg/m².

The researchers also created a weighted healthy lifestyle score in which each lifestyle factor was weighted according to its independent magnitude of effect on HF risk.

The primary outcome was hospitalization for HF. Mean follow-up was 11 years.

During the study period, and colleagues observed 1,826 cases of HF.

A healthy lifestyle score was strongly associated with risk for HF. Compared with women who had a score of 0, women had a decreased risk for HF if they had a higher score of 1 (HR=0.49; 95% CI, 0.38-0.62), 2 (HR=0.36; 95% CI, 0.28-0.46), 3 (HR=0.24; 95% CI, 0.19-0.31) or 4 (HR=0.23; 95% CI, 0.17-0.3).

The healthy lifestyle score also was strongly associated with HF risk among women without prior CHD, diabetes or hypertension.

Comparing the highest tertile to the lowest tertile, the healthy lifestyle score (HR=0.46; 95% CI, 0.41-0.52) and the weighted healthy lifestyle score (HR=0.48; 95% CI, 0.42-0.55) were similar, according to the researchers. Therefore, they concluded, weighting the lifestyle factors did not make much of an impact.

Paul A. Heidenreich, MD, a cardiologist at the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif., wrote in a related editorial that these findings are important because by 2030, one in 33 people in the United States is projected to have HF. “If we can identify the important components of a healthy lifestyle, we can create incentives for patients to live a healthy life, reduce the incidence of disease and lower health care costs.”

However, Heidenreich cautioned against the emerging trend of employers sanctioning employees for unhealthy outcomes. He argued that there is evidence for substantial hereditability for weight and BMI, so therefore “for now, we should limit employee and patient rewards to healthy choices (diet, exercise, lack of smoking) and not equate these with healthy outcomes.”

For more information:

Agha G. J Am Coll Cardiol. 2014;64:1777-1785.

Heidenreich PA. J Am Coll Cardiol. 2014;64:1786-1788.

Disclosure: The study was funded by and one researcher reports receiving grants from the NIH. The other researchers and Heidenreich report no relevant financial disclosures.