February 28, 2017Journal of the American College of Cardiology
Relationship Between Physical Activity, Body Mass Index, and Risk of Heart Failure
Key result
High leisure-time physical activity is linked to ~19% lower HFpEF risk compared to inactivity.
- hazard ratio 0.81
- 95% CI 0.68 to 0.97
- n=51,451
Why the study?
It was unclear whether the independent associations of lower leisure-time physical activity and higher BMI with heart failure risk were consistent for both HFpEF and HFrEF.
Does higher leisure-time physical activity and lower body mass index prevent the development of heart failure subtypes (HFpEF vs HFrEF) in adults without baseline cardiovascular disease?
Key Points
- To determine the dose-response relationships between leisure-time physical activity, body mass index, and the risk of heart failure subtypes, specifically HFpEF and HFrEF.
- Pooled individual-level data from 51,451 participants across three prospective cohorts (WHI, MESA, and CHS) spanning 645,515 person-years of follow-up.
- Assessed incident overall heart failure, HFpEF (ejection fraction ≥45%), and HFrEF (ejection fraction <45%) using multivariable adjusted Cox proportional hazards models and restricted cubic splines.
- During follow-up, 3,180 incident heart failure events occurred (1,252 HFpEF, 914 HFrEF, and 1,014 unclassified).
- Leisure-time physical activity was not associated with HFrEF risk at any dose, whereas activity >1,000 MET-min/week was associated with a 19% lower risk of HFpEF (HR: 0.81; 95% CI: 0.68 to 0.97).
- Higher body mass index demonstrated a significant graded relationship with HFpEF risk (p trend < 0.0001) but not HFrEF (p trend = 0.07), with overweight and class I obesity carrying 38% and 56% higher HFpEF risks, respectively.
Study Design
Type
Cohort (n=51,451)
Multicenter
Yes
Structured PICO
Does higher leisure-time physical activity and lower body mass index prevent the development of heart failure subtypes (HFpEF vs HFrEF) in adults without baseline cardiovascular disease?
P
Population
51,451 community-dwelling adults from three large US cohorts (WHI, MESA, CHS) without prevalent heart failure, pooled to evaluate the risk of heart failure subtypes based on leisure-time physical activity and BMI.
E
Exposure
Higher levels of leisure-time physical activity (>1,000 MET-min/week) and varying BMI levels
C
Comparator
No leisure-time physical activity (0 MET-min/week) and normal body mass index (18.5 to <25 kg/m²)
O
Outcome
Incidence of overall heart failure and its subtypes, HFpEF (ejection fraction ≥45%) and HFrEF (ejection fraction <45%)hard clinical
Main Result
Hazard Ratio: 0.81 (95% CI 0.68–0.97)
Higher leisure-time physical activity and lower BMI have a stronger, more consistent dose-dependent association with reducing the risk of HFpEF compared to HFrEF.
Limitations
- Potential for residual or unmeasured confounding due to observational design
- Measurement errors in body weight, height, and self-reported physical activity levels
- Focus restricted to leisure-time physical activity without evaluating occupational or total physical activity
- Ejection fraction information missing in 32% of the incident HF cases
- Inability to completely exclude the potential for reverse causation
- Observational nature with potential residual or unmeasured confounding
- Measurement errors in self-reported physical activity and BMI
- Did not evaluate occupational or total physical activity
- EF information was missing in 32% of incident HF cases
- Cannot completely exclude the potential for reverse causation
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We consistently found an association between physical activity, BMI and overall heart failure risk. This was not unexpected, however the impact of these lifestyle factors on heart failure subtypes was quite different.”
“There was a distinct relationship between both physical activity and BMI and the different heart failure subtypes, which may have important clinical and public health implications. These data suggest the importance of modifying lifestyle patterns to help prevent HFpEF in the general population.”
“have provided strong evidence that lack of physical activity is associated with incident HFpEF.”
Implication
May support activity counseling to lower HFpEF risk in primary prevention; extends observational data but leaves causality and trial confirmation open.
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Cite This Study
Pandey et al. (2017) conducted a cohort in Heart Failure (n=51,451). Leisure-time physical activity (LTPA) vs. No leisure-time physical activity was evaluated on Risk of HFpEF (hazard ratio 0.81, 95% CI 0.68 to 0.97). Higher than twice the guideline-recommended minimum leisure-time physical activity (>1,000 MET-min/week) was associated with a 19% lower risk of HFpEF compared with no leisure-time physical activity (HR 0.81, 95% CI 0.68 to 0.97).