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High BMI, lower physical activity linked to higher HF risk
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BMI and leisure-time physical activity have been connected to overall HF risk, especially in HF with preserved ejection fraction, according to findings published in the Journal of the American College of Cardiology.
“These findings suggest the possible preventive role of lifestyle patterns for HFpEF in the community,” Jarrett D. Berry, MD, MS, preventive cardiologist and associate professor in the department of internal medicine at the University of Texas Southwestern Medical Center in Dallas, and colleagues wrote. “In addition, these findings could also have implications for future guidelines aimed at the prevention of HFpEF in the general population.”
Researchers analyzed data from 51,451 participants. This information was assembled from three large cohort studies: Women’s Health Initiative (WHI; 77.2%), Multi-Ethnic Study of Atherosclerosis (MESA; 13.1%) and Cardiovascular Health Study (CHS; 9.7%). Participants in the current study did not have frequent HF or MI at baseline, had measurable data for BMI and leisure- time physical activity, and were followed up for CV outcome findings.
Other characteristics that were reviewed were sex, age, ethnicity, education level, annual income, baseline BP, BMI, leisure-time physical activity, diabetes, smoking and history of hypertension.
The primary outcomes of interest were the rates of overall HF and its subtypes, HFpEF and HF with reduced ejection fraction.
Participants from the three cohorts were stratified by their leisure-time physical activity: none, less than minimum recommended (1 to < 500 metabolic equivalent of task [MET] minutes per week), guideline-recommended (500-1,000 MET minutes per week) and more than recommended (> 1,000 MET minutes per week).
Participants who reported with higher levels of physical activity were generally white men with a higher education level and annual income. Participants of both sexes in this category had significantly lower prevalence of diabetes, hypertension, obesity and smoking. Higher prevalence of these CV risk factors was seen in younger participants with higher BMI and lower levels of physical activity.
Researchers followed up with participants after 645,515 person-years, and 3,180 HF events were detected. HFpEF accounted for 39.4% of events (n = 1,252), 28.7% of those were HFrEF (n = 914) and 31.9% were uncategorized (n = 1,014).
Compared with participants with no physical activity, those with low levels experienced a 6% lower risk for HF. There was a stronger association between higher levels of physical activity and lower HF risk: 11% lower in those with guideline-recommended levels and 22% lower in those with more than recommended levels.
The occurrence of HFpEF was lower for participants with higher physical activity (log-rank P = .04), but the relationship was not statistically significant for HFrEF (log-rank P = .167). Those with more than the recommended amount of physical activity had a 19% lower risk for HFpEF. A dose-dependent association was examined between activity levels and the HR for HFpEF (P for trend for HR = .006), but was not observed in the risk for HFrEF (P for trend for HR = .182).
There was not a significant connection between the levels of physical activity and HFrEF (adjusted HR = 0.95; 95% CI, 0.89-1.02), but there was a dose-dependent association between these two factors (adjusted HR = 0.91; 95% CI, 0.85-0.97). There was not a substantial interaction between activity levels and the risk for HF and its subtypes for ethnicity, sex, income and education status (P for interaction > .2 for all), according to the researchers.
Participants with higher BMI had increased incidence of HFpEF (log-rank P < .0001), but there was no relationship between BMI and HFrEF (log-rank P = .154). HFrEF risk was not different between participants who were overweight or obese vs. normal weight, but HFpEF risk was significant for participants who were overweight (38% higher risk) and obese (56% higher risk) vs. those with normal weight.
“Based on several studies, it seems that a lack of physical activity results in abnormalities in multiple organ systems and molecular pathways that give rise to the ‘perfect storm’ for the development and progression of HFpEF,” Sanjiv J. Shah, MD, professor of medicine (cardiology) at Northwestern University Feinberg School of Medicine, wrote in a related editorial. “Conversely, moderate or greater intensity of regular physical activity is protective against the development of these abnormalities.” – by Darlene Dobkowski
Disclosure: Berry reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures. Shah reports receiving research funding from Actelion, AstraZeneca, Corvia and Novartis; and consultant fees from Actelion, AstraZeneca, Bayer, Ironwood, Merck, Novartis and Sanofi.
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