Abstract P154: Healthy Lifestyle and Risk of Incident Heart Failure With Preserved and Reduced Ejection Fraction in Postmenopausal Women: The Women’s Health Initiative Study

Abstract

Background: Heart failure (HF) is a growing health concern in the United States. Lifestyle risk factors including diet, physical activity, cigarette smoking, and body mass index (BMI), have been shown to be independently and jointly associated with incident heart failure. However, these associations have not been evaluated for HF subtypes, HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). Objective: To assess the combined associations of diet, physical activity, cigarette smoking, and BMI with risk of HFpEF and HFrEF subtypes. Methods: 39,893 postmenopausal women aged 50-79, without self-reported HF at baseline, were included in this analysis. A lifestyle score was created following a similar method previously used in WHI, defining the following healthy criteria: high diet quality (Alternate Healthy Eating Index quintile 4 or 5), being physically active (more than 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise or equivalent combination), not a current cigarette smoker, and BMI between 18.5 and 25 kg/m 2 . Women received 1 point for each healthy criterion that was met, and points were summed to obtain the healthy lifestyle score, ranging in value from 0 (least healthy) to 4 (most healthy). Trained adjudicators determined cases of incident heart failure through 2018, defining HFpEF as EF≥45% and HFrEF as EF<45%. Results: Over a mean follow-up of 14.5 years, 2426 HF incident hospitalized cases were documented and confirmed, classifying 1345 cases as HFpEF and 685 cases as HFrEF. Healthy lifestyle was strongly associated with a decreased risk of both HFpEF and HFrEF (Table). Conclusion: Findings suggest that a healthy lifestyle may be associated with decreased risk of HF subtypes among postmenopausal women. Results from this research provide a better understanding of the role of modifiable lifestyle factors in each of the HF subtypes, allowing for the development of more targeted primary and secondary prevention strategies specific to HFpEF and HFrEF.