Background
The impact of a healthy lifestyle on risk of heart failure (HF) is not well known.
Objective
To evaluate the effect of a combination of lifestyle factors on incident HF, and further investigate whether weighting each lifestyle factor has additional impact.
Methods
Participants were 84,537 post-menopausal women from the Women's Health Initiative Observational Study, free of self-reported HF at baseline. A healthy lifestyle score (HL-score) was created, where 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 where each lifestyle factor was weighted according to its independent magnitude of effect on HF. Incident 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 HR [95% CI] = 0.49 [0.38,0.62], 0.36 [0.28,0.46], 0.24 [0.19,0.31], and 0.23 [0.17,0.30] for HL-score of 1,2,3,4 vs 0, respectively]. The HL-score and wHL-score were similarly associated with HF risk (HR [95% CI] = 0.46 [0.41,0.52] for HL-score and 0.48 [0.42,0.55] 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.