Association of ideal cardiovascular health and Life's Simple 7 metrics with incident heart failure among older men: the British Regional Heart Study

BACKGROUND: Ideal cardiovascular health (CVH) determined by categorisation of component Life's Simple 7 (LS7) metrics has been associated with reduced risk of heart failure (HF). However, few studies have explored the relationship between changes in CVH from middle to older age and HF incidence. AIMS: We aim to investigate the association between LS7 metrics and their impact on HF incidence in older men. Additionally, we explore whether changes in CVH scores between middle and older age were associated with subsequent HF risk. METHODS: The British Regional Heart Study is a prospective study of 7735 men, aged 40-59y at enrolment (1978-1980) from 24 British towns. Information on LS7 metrics was gathered at initial recruitment and again at re-examination 20y later. Follow-up for HF was conducted from re-examination onwards. RESULTS: Among 3698 men (60-79y) without prior myocardial infarction or HF, 369 developed HF during a median follow-up of 15.8y. Ideal CVH was associated with significantly lower risk of HF relative to poor CVH after adjusting for age, social class and alcohol intake (HR 95%CI = 0.51 0.38-0.68). Men who maintained high CVH scores between baseline and 20y re-examination (high-high group) showed a significant 33% reduction in risk of HF (HR 95%CI= 0.67 0.51-0.87) compared to those with consistently low CVH scores. These associations persisted after adjustment for competing mortality. CONCLUSIONS: Our results highlight that a consistently healthy lifestyle, as reflected in a better CVH score maintained over an adult lifetime, is associated with lower HF risk in older men.