Relationship Among Physical Activity, BMI, and Risk of Heart Failure
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Lower leisure-time physical activity (LTPA) and higher body mass index (BMI) are independently associated with risk of heart failure (HF). However, it is unclear if this relationship is consistent for both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
OBJECTIVES
This study sought to quantify dose-response associations between LTPA, BMI, and the risk of different HF subtypes.
METHODS
Individual-level data from 3 cohort studies (WHI [Women's Health Initiative], MESA [Multi-Ethnic Study of Atherosclerosis], and CHS [Cardiovascular Health Study]) were pooled and participants were stratified into guideline-recommended categories of LTPA and BMI. Associations between LTPA, BMI, and risk of overall HF, HFpEF (ejection fraction ≥45%), and HFrEF (ejection fraction <45%) were assessed by using multivariable adjusted Cox models and restricted cubic splines.
RESULTS
The study included 51,451 participants with 3,180 HF events (1,252 HFpEF, 914 HFrEF, and 1,014 unclassified HF). In the adjusted analysis, there was a dose-dependent association between higher LTPA levels, lower BMI, and overall HF risk. Among HF subtypes, LTPA in any dose range was not associated with HFrEF risk. In contrast, lower levels of LTPA (<500 MET-min/week) were not associated with HFpEF risk, and dose-dependent associations with lower HFpEF risk were observed at higher levels. Compared with no LTPA, higher than twice the guideline-recommended minimum LTPA levels (>1,000 MET-min/week) were associated with an 19% lower risk of HFpEF (hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.97). The dose-response relationship for BMI with HFpEF risk was also more consistent than with HFrEF risk, such that increasing BMI above the normal range (≥25 kg/m(2)) was associated with a greater increase in risk of HFpEF than HFrEF.
CONCLUSIONS
Our study findings show strong, dose-dependent associations between LTPA levels, BMI, and risk of overall HF. Among HF subtypes, higher LTPA levels and lower BMI were more consistently associated with lower risk of HFpEF compared with HFrEF.
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Relationship Between Physical Activity, Body Mass Index, and Risk of Heart Failure
J Am Coll Cardiol 2017 Mar 07;69(9)1129-1142, A Pandey, M LaMonte, L Klein, C Ayers, BM Psaty, CB Eaton, NB Allen, JA de Lemos, M Carnethon, P Greenland, JD BerryFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Heart failure with preserved ejection fraction (HFpEF) presently constitutes approximately 50% of heart failure (HF) cases and is expected to be the dominant form of hospitalized HF cases by 2020. HF in general is prospectively associated with lower levels of leisure time physical activity (LTPA) and increased body mass index (BMI), but it is not clear if the same risk factors apply to both heart failure with reduced ejection fraction (HFrEF) and HFpEF.
Pandey and colleagues used data from three large prospective studies (the Women’s Health Initiative, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study) to examine prospectively the relationship among LTPA, BMI, and HFpEF and HFrEF. These studies included 51,451 participants and yielded 3180 HF events, including 1252 HFpEF, 914 HFrEF, and 1014 events that were undetermined. HFpEF was defined as an EF ≥45%.
For all types of HF, lower levels of LTPA and higher BMI were associated with increased HF risk. The relationships of these risk factors to HF were more complex when the different forms of HF were examined. LTPA at any level was not associated with the development of HFrEF. Low levels of LTPA were also not associated with the development of HFpEF, but higher levels of LTPA were inversely related to the development of HFpEF, indicating that higher levels of LTPA appear to reduce the risk of HFpEF. Increasing BMI was also more clearly related to HFrEF than to HFpEF, suggesting that increased BMI contributes to the development of HFpEF, but possibly has less influence on the development of HFrEF.
These results will not change present clinical recommendations since the benefits of LTPA and reduced BMI are established and extend well beyond HF risk alone. Nevertheless, these results may contribute to a better understanding of the physiology factors contributing to HFpEF and eventually improve its prevention and management.