COMMENTARY

Could Lifestyle Factors Prevent Heart Failure in Women?

JoAnn E. Manson, MD, DrPH

Disclosures

February 24, 2015

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Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you today about a recent study[1] that linked a healthy lifestyle score to a lower risk for heart failure among women in the large-scale Women's Health Initiative.

The study was published in the Journal of the American College of Cardiology and included more than 84,000 women and more than 1800 incident cases of hospitalized heart failure. I'd like to acknowledge that I was a coauthor of this report.

Heart failure is a major public health concern—high prevalence, generally poor clinical outcomes. Any role of lifestyle modifications in the primary prevention of this disease would be of major public health importance.

We know that healthy lifestyle practices have been linked to a reduced risk for heart disease, stroke, and type 2 diabetes. Some studies suggest even an 80% lower risk for these conditions among those following healthy lifestyle practices compared with those who don't.

In the current study, we looked at a healthy lifestyle score that included having regular physical activity (reaching a target goal for moderate- or vigorous-intensity exercise), having a healthy body weight (not being overweight or obese), having a high-quality diet (high score on an alternative healthy eating index), and not smoking.

These lifestyle factors, both individually and collectively, were associated with a substantially lower risk for heart failure. In fact, the women who followed all four of these practices had a 77% lower risk for heart failure than did the women following none of them.

We estimated that in the overall cohort, if all of the women had followed these four lifestyle practices, about 35% of the cases of heart failure could have been prevented.

We also found similar risk reductions among the women who didn't have a prior history of heart disease as for women who had an antecedent history of coronary disease. So, even among those without antecedent coronary disease for nonischemic etiology heart failure, we saw substantial reductions in risk for hospitalized heart failure with these lifestyle practices.

We saw similar reductions in risk comparable for African American and white women.

This is an observational study and it has some limitations. There can be residual confounding factors and it can't prove causality. We need randomized trials. Some randomized trials are in progress. For example, the Women's Health Initiative is just starting a pragmatic trial of physical activity, and heart failure will be one of the outcomes looked at.

In the VITamin D and OmegA-3 triaL (VITAL), we're looking at nutritional factors in reducing the risk for heart failure.

There are other trials that are ongoing, looking at lifestyle modifications, but generally there are few trials of this nature. More clinical trial research would be of great value.

I think we already know that lifestyle practices are linked to reduced risk for many chronic diseases, such as heart disease, stroke, and type 2 diabetes. We have more than enough reason to recommend these lifestyle practices to our patients—even to get out the prescription pad and write a prescription for physical activity and other lifestyle modifications that have been found to be of benefit.

Thank you so much for your attention. Please include your comments below.

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