Abstract MP47: Contribution of Preventable Risk Factors for Incident Congestive Heart Failure in Older Adults: the Cardiovascular Health Study

Abstract

Background: Heart failure (HF) incurs high morbidity, mortality and health care costs among adults ≥65 years, the most rapidly growing segment of the US population. The relative contribution of lifestyle factors on incident HF, including total dietary pattern, physical activity, smoking, alcohol, and obesity, has not been established. Methods: We prospectively investigated the contribution of major preventable risk factors, measured using repeated assessments, on incident HF among 4490 men and women ≥65 years in the Cardiovascular Health Study, a community-based US cohort. Lifestyle factors included four diet patterns (Biologic, DASH, AHEI, AHA 2020), four physical activity metrics (exercise intensity, walking pace, walking distance leisure activity), alcohol intake, smoking, and obesity. Incident HF was adjudicated by a centralized committee using medical records, diagnostic tests, and interviews. Adults with baseline CHF, moderate or severe mitral or aortic regurgitation, or missing lifestyle information were excluded from analysis. Risk associated with each lifestyle factors was assessed using Cox proportional hazards models. Results: Over 21-years (51849 person-years), 1380 cases of HF occurred. After multivariable adjustment, no dietary pattern was associated with incident HF ( p >0.05), although sodium intake was associated with increased risk in secondary analyses. In contrast, walking pace, leisure activity, modest alcohol intake, former or never smoking, and BMI<30kg/m 2 were independently associated with lower risk of HF, with the highest population attributable risks for alcohol intake (18%) and physical activity (18%), followed by BMI (8%) and smoking (5%) (Table). Conclusion: Surprisingly, overall dietary patterns were not associated with HF, although sodium intake was associated with increased risk. Key modifiable risk factors to be targeted for HF prevention in older adults include physical activity and alcohol intake, obesity and smoking.