Abstract
Several lifestyle factors have been linked to risk for heart failure (HF) and premature mortality. The aim of this study was to estimate the impact of a healthy lifestyle on life expectancy with and without HF among men and women from a general population. This study was performed among 6113 participants (mean age 65.8 ± 9.7 years; 58.9% women) from the Rotterdam Study, a large prospective population-based cohort study. A continuous lifestyle score was created based on five lifestyle factors: smoking status, alcohol consumption, diet quality, physical activity and weight status (assessed 1995–2008). The lifestyle score was categorized into three levels: unhealthy (reference), intermediate and healthy. Gompertz regression and multistate life tables were used to estimate the effects of lifestyle on life expectancy with and without HF in men and women separately at ages 45, 65 and 85 years (follow-up until 2016). During an average follow-up of 11.3 years, 699 incident HF events and 2146 deaths occurred. At the age of 45 years, men in the healthy lifestyle category had a 4.4 (95% CI: 4.1–4.7) years longer total life expectancy than men in the unhealthy lifestyle category, and a 4.8 (95% CI: 4.4–5.1) years longer life expectancy free of HF. Among women, the difference in total life-expectancy at the age of 45 years was 3.4 (95% CI: 3.2–3.5) years and was 3.4 (95% CI: 3.3–3.6) years longer for life expectancy without HF. This effect persisted also at older ages. An overall healthy lifestyle can have a positive impact on total life expectancy and life expectancy free of HF.
Highlights
Heart failure (HF) has a prevalence of around 1–2% of the adult population and a high disease burden [1,2,3,4]
Which we used as a proxy for socio-economic status, there are minor differences between the included group and the group without lifestyle score, e.g. 11.7% of women included in the analysis had higher education, versus 10.4% of women in the group not included in the analysis (Supplementary Table 3)
We found that a healthy overall lifestyle in middle-aged and elderly is associated with a longer total life expectancy and years lived without heart failure, in both men and women
Summary
Heart failure (HF) has a prevalence of around 1–2% of the adult population and a high disease burden [1,2,3,4]. Several lifestyle factors have been separately studied in relation to HF risk. A normal weight [7], healthy diet [8, 9], no or low alcohol consumption [10,11,12] and no smoking [13, 14] have been linked to a decreased risk of HF. These lifestyle factors are interrelated, and their effect should be considered in conjunction.
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