Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study
Department of Quantitative Health Sciences; Department of Medicine, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center
Aged; Body Mass Index; Body Weight; Feeding Behavior; Female; Heart Failure; Hospitalization; Humans; *Life Style; Middle Aged; Postmenopause; Prospective Studies; Risk Factors; Smoking; Women's Health
Behavior and Behavior Mechanisms | Cardiology | Cardiovascular Diseases | Community Health and Preventive Medicine | Epidemiology | Health Services Research | Women's Health
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. Elsevier Inc. All rights reserved.
DOI of Published Version
J Am Coll Cardiol. 2014 Oct 28;64(17):1777-85. doi: 10.1016/j.jacc.2014.07.981.Link to article on publisher's site
Journal of the American College of Cardiology
Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, Li W, Martin LW, Greenland P, Manson JE, Eaton CB. (2014). Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jacc.2014.07.981. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1144