LAS VEGAS – Not smoking, maintaining a normal body weight, exercising regularly, and eating a healthy diet would avert roughly 40% of all cases of heart failure, Dr. Luc Djousse asserted at the annual meeting of the Heart Failure Society of America.
“Those four simple lifestyle changes offer a cost-effective opportunity for primary prevention of heart failure in the population,” observed Dr. Djousse, director of research in the division of aging at Brigham and Women’s Hospital, Boston.
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Not smoking, maintaining a normal body weight, exercising regularly, and eating a health diet would avert 40% of heart failure cases.
The evidence to back his claim comes chiefly from well-conducted epidemiologic studies. For example, in the Physicians Health Study I, involving nearly 21,000 male physicians followed for a mean of 22 years, 40-year-olds who didn’t adhere to any of six key lifestyle factors – maintaining normal body weight, not smoking, regular exercise, moderate alcohol intake, consumption of fruits and vegetables, and eating breakfast cereals – had a lifetime heart failure risk of 21%.(JAMA 2009;302:394-400). “That’s right,” he asserted, “even if you’re a physician.”
In contrast, physicians who adhered to four or more of the six lifestyle factors cut their lifetime risk of heart failure by more than half, to 10.1%.
Similarly, a Finnish national population-based study of 18,346 men and 19,729 women who were ages 25-74, free of heart failure at baseline, and followed for a median of 14.1 years found that women who engaged in four healthy lifestyle behaviors -- not smoking, maintaining normal body weight, physical activity, and liberal intake of vegetables -- were an adjusted 81% less likely to develop heart failure than women who didn’t adhere to any of the four behaviors. Men who followed the four-fold path were 69% less likely to develop heart failure, again after adjusting for age, blood pressure, lipid levels, education, and history of heart disease (Circ. Heart Fail. 2011;4:607-12).
Dr. Djousse said that while Framingham Heart Study data show that hypertension accounts for 39% of the population-attributable risk for heart failure in men and 59% in women, analysis of Physicians Health Study data underscore the negative impact of unhealthy and modifiable lifestyle factors. In that analysis, smoking accounted for 20% of the population attributable risk for heart failure, being sedentary accounted for 12%, alcohol consumption of less than 1 drink per week 10%, and dietary shortcomings less than 10%.
In this analysis, individual dietary aspects made a relatively modest contribution to the incidence of heart failure compared to other modifiable lifestyle factors. Yet dietary issues are a neverending source of fascination both for the general public and physicians. So Dr. Djousse’s update on the evidence regarding a number of hot dietary topics received close attention:
Coffee: A meta-analysis of five prospective studies totalling more than 140,000 participants found a J-shaped dose-response relationship. Consumption of 4 cups per day was optimal, with an associated roughly 10% reduction in heart failure risk (Circ. Heart Fail. 2012;5:401-05). This information elicited a spontaneous cheer -- more of a roar, actually -- from Dr. Djousse’s large audience.
Red meat: In a population-based study of more than 37,000 Swedish men, consumption of at least 75 g/day of processed red meat, such as salami or prosciutto, was independently associated with a 28% increased risk of developing heart failure compared to that of men who ate less than 25 g/day. Intake of unprocessed red meat was unrelated to heart failure risk (Circ. Heart Fail. 2014;7:552-57).
Alcohol: A six-study meta-analysis by Dr. Djousse and coinvestigators concluded that light-to-moderate drinking was associated with a 23% reduction in the risk of heart failure compared to never drinkers. They defined moderate drinking as one to two drinks per day in men and one in women (Phys. Sportsmed. 2010; 38:84-89).
Fish: In a meta-analysis of seven prospective studies featuring more than 176,000 subjects and 5,480 incident cases of heart failure, regular fish consumption was associated with a 15% reduction in the risk of heart failure compared to the lowest category of fish intake (Clin. Nutr. 2012;31:846-53).
Chocolate: Among nearly 32,000 women participating in the prospective Swedish Mammography Cohort study, consumption of one or two servings of chocate per week was associated with a 32% reduction in the risk of incident heart failure in a multivariate analysis compared to no regular chocolate intake. However, no protective effect was seen with consumption or one or more daily servings (Circ. Heart Fail. 2010;3:612-16). Evidence from other studies suggests that dark chocolate, which is rich in cocoa flavinoids, is the type with the most cardioprotective effects, according to Dr. Djousse.