An overall heart-healthy lifestyle is needed to prevent heart failure

After evaluating 5 lifestyle factors and their impact on heart failure outcomes – smoking status, alcohol consumption, diet quality, physical activity and weight – the authors of a new study in European Journal of Epidemiology determined that a healthy lifestyle has a positive impact on both overall life expectancy and heart failure-free years.

Noting that previous studies have investigated the independent association of each of the above factors with heart failure risk and mortality outcomes, the authors wrote, “These lifestyle factors are interrelated and their effect should therefore be considered together. Our main objective was therefore to answer the etiological question of whether overall lifestyle influences the average number of years lived with and without heart failure.

The lifestyle score created from the 5 factors mentioned above was stratified into 3 levels: unhealthy (baseline; 0-3), moderate (4-6) and healthy (7-10).

Data for the factors were collected from 1995 to 2008 on 6113 individuals (average [SD] age, 65.8 [9.7] years; women, n=3598; men, n = 2515). Most were classified as overweight (41.6%, women; 54.5%, men), followed by normal weight (33.5% and 30.3%, respectively) or obese (25.0% and 15.2%). More women than men had no smoking history (44.2% versus 16.5%), and more men than women were current smokers (22.6% versus 17.2% ).

Reduced risks of incident heart failure were seen in those with healthy versus unhealthy lifestyle scores. For men, their risk of heart failure was reduced by 53% and for women by 30%. Additionally, each 1-point increase in Lifestyle Score was correlated with overall risk reductions of 11% and 9%, respectively. Mortality risks were also reduced, but not by much: 11% in men and 13% in women.

In study participants without heart failure, a healthy versus an unhealthy lifestyle was correlated with a 45% reduced risk of premature death in men and 39% in women. The transition from no heart failure to first event was most strongly influenced by weight relative to other lifestyle factors, and from heart failure to death, smoking status had the most influence. .

Longer overall life expectancies were observed in women and men, as well as in those without heart failure, when comparing the healthy and moderate lifestyle categories with the unhealthy lifestyle category, respectively at ages 45, 65 and 85 years old.

The following increases in total life expectancy were observed for the moderate and lifestyle category scores, respectively, compared to the unhealthy category scores:

  • 45-year-old men: 2.1 and 4.4 years
  • Women aged 45: 2.3 and 3.4 years
  • 65-year-old men: 1.7 and 4.0 years
  • Women aged 65: 2.0 and 3.1 years
  • 85-year-old men: 0.8 and 2.0 years
  • Women aged 85: 1.0 and 1.6 years

The corresponding heart failure free life years gained are 2.1 and 4.8, 1.8 and 4.4, and 0.9 and 2.3 years in men and 2.3 and 3.4.2 .0 and 3.1, and 1.1 and 1.7 in women.

The last year of study follow-up was 2016, and the average follow-up was 11.3 years. Heart failure events totaled 699 (females, n=379; males, n=320) and 35% (females, n=1149; males, n=997) of the entire study cohort are deceased. This study was a sub-analysis of 3 sub-cohorts of the Rotterdam study, the Netherlands. Physical activity levels, smoking, alcohol consumption, and diet quality were self-reported; weight status was determined by research center staff; and heart failure was diagnosed according to the criteria of the European Society of Cardiology.

The authors did not find that one lifestyle factor exerted a greater influence on the 5s than the others, and they attribute this to the fact that all of the lifestyle factors they assessed were influences. important. “Indeed, several mechanisms have been proposed to contribute to the association between individual lifestyle factors and heart failure,” they wrote.

Several examples include that poor diet and little physical activity can lead to higher body mass index and inflammation, which in turn can lead to hypertension and diabetes; heavy alcohol consumption can damage the heart muscle; and smoking can lead to hypertension and coronary heart disease. All of these are major causes of heart failure, the authors noted, adding that their findings also echoed previous studies.

“We add to the literature that an overall healthy lifestyle can not only improve total life expectancy, but also life expectancy without heart failure, and that there is not a major determining factor” , they concluded. “Focusing on a healthy lifestyle in the prevention and treatment of heart failure is of major importance and should also be addressed in the older population. Hereby, emphasis should be placed on the mode global life and not just on a single aspect.


Limpens MAM, Asllanaj E, Dommershuijsen LJ, et al. Healthy lifestyle in the elderly and life expectancy with and without heart failure. Eur J Epidemiol. Published online January 27, 2022. doi:10.1007/s10654-022-00841-0

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