Impact of changes in physical activity or BMI on risk of heart failure in women – the prospective population study of women in Gothenburg

Objective: To longitudinally evaluate the impact of change in physical activity or change in body mass index (BMI) over time on the risk of developing heart failure (HF) in women without a previous diagnosis of HF.Design and setting: Longitudinal, observational, prospective study of women in Gothenburg, Sweden. Data on BMI and level of physical activity were collected from examinations 1968–1992 and hospital diagnoses and mortality data were ascertained from 1980 to 2012.Subjects: Data were obtained from 1749 women included in the Prospective Population Study of Women in Gothenburg.Main outcome measures: Hazard ratio (HR) for HF was calculated, using a Cox regression model.Results: Women with stable high physical activity during 1968–1980 and 1980–1992 reduced their risk of subsequent HF compared to the non-active women (for 1968–1980 HR 0.66, 95% Confidence Interval (CI) 0.44–0.99 and for 1980–1992 HR 0.47, 95% CI 0.29–0.74). Women with increasing levels of physical activity during 1980–1992 reduced their risk of HF compared to the non-active women (HR 0.40, 95% CI 0.22–0.72). Increase in BMI from overweight to obesity during 1968–1980 predicted increased risk of developing HF (HR 1.93, 95% CI 1.18–3.14).Conclusions: Reduced risk of future HF in healthy women may be achieved by remaining physically active from young middle age and throughout life or by increasing the level of physical activity. This is particularly important for sedentary women in middle age. The role of physical activity in preventing the development of obesity must be taken into account.Key pointsA sedentary lifestyle and obesity are risk factors for developing heart failure (HF) in women.The risk of developing HF may be reduced by increasing the level of activity in sedentary middle-aged women.For younger women, avoiding obesity is most important to reduce the risk of later HF.Primary care has a key role in guiding women towards the most effective lifestyle changes to prevent development of HF.