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J Am Coll Cardiol. 2014 Oct 28;64(17):1777-85. doi: 10.1016/j.jacc.2014.07.981. Epub 2014 Oct 21.

Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study.

Author information

  • 1Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts. Electronic address: gagha@hsph.harvard.edu.
  • 2Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
  • 3Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • 4Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
  • 5Ohio State University, College of Public Health, Columbus, Ohio.
  • 6Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
  • 7George Washington University School of Medicine and Health Sciences, Washington, DC.
  • 8Northwestern University Feinberg School of Medicine, Chicago, Illinois.
  • 9Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • 10Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.

Abstract

BACKGROUND:

The impact of a healthy lifestyle on risk of heart failure (HF) is not well known.

OBJECTIVES:

The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact.

METHODS:

Participants were 84,537 post-menopausal women from the WHI (Women's Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology.

RESULTS:

There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension.

CONCLUSIONS:

An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.

KEYWORDS:

cardiovascular diseases; heart failure; lifestyle; primary prevention; risk factors

Comment in

PMID:
25443698
PMCID:
PMC4254927
DOI:
10.1016/j.jacc.2014.07.981
[PubMed - indexed for MEDLINE]
Free PMC Article
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