Abstract 11894: Leisure-Time Physical Activity in Late-Life is Associated With Risk of Heart Failure With Preserved and Reduced Ejection Fraction - The Atherosclerosis Risk in Communities Study

Abstract

Introduction: Leisure-time physical activity (LTPA) is associated with lower heart failure (HF) risk. However, reported associations with incident HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) differ and whether these associations persist into-late life is unclear. Methods: We evaluated 5017 participants in the Atherosclerosis Risk in Communities study who attended visit 5 (2011-2013) and did not have prior HF or significant valvular heart disease. LTPA was assessed by the Baecke questionnaire, summarized in metabolic equivalent (MET)-minutes/week, and related to incident HFpEF (EF ≥ 50%) and HFrEF (EF < 50%) using multivariable Cox regression and restricted cubic splines. All models were adjusted for age, sex, race, center, and smoking status. Results: The mean age was 75.5 ± 5.0 years, 41% were male, 21% Black, and median LTPA was 624 [IQR 0-1270] MET-min/wk. Over a median follow-up of 7.2 years, 435 participants developed HF (208 HFpEF, 166 HFrEF, 61 unknown EF). Compared to those with low LTPA levels (1 st tertile; <139 MET-min/wk), higher levels of LTPA (3 rd tertile; >1053 MET-min/wk) were significantly associated with lower HF risk (HR 0.48 [95% CI 0.37-0.62]) after adjusting for age, sex, race, center, and smoking status. The 2 nd and 3 rd tertile remained associated with lower HFpEF risk (2 nd tertile: HR 0.69 [0.50-0.96]; 3 rd tertile: 0.43 [0.29-0.62]), and lower HFrEF risk (2 nd tertlle: HR 0.55 [0.37-0.81]; 3 rd tertile: 0.57 [0.39-0.85]) in the adjusted model. Restricted cubic splines demonstrated a graded response between higher levels of LTPA and incident HFpEF and HFrEF (Figure). With further adjustment for HF risk factors that may be considered mediators, the association of higher LTPA with lower risk of HFpEF was preserved while the association with HFrEF risk was attenuated. Conclusions: In older adults, higher levels of LTPA are associated with a lower risk of both incident HFpEF and HFrEF.