Greater physical activity may be associated with reduced risk for heart failure in several high-risk subgroups, according to study results published in the Journal of the American Heart Association.1

Physical activity is associated with reduced risk for heart failure, but it is unclear if this protective effect extends to all at-risk populations. Using data from the Atherosclerosis Risk in Communities (ARIC) study, investigators aimed to evaluate the effect of physical activity on heart failure incidence among subgroups of high-risk patients.

Subgroups were defined according to the 2013 American College of Cardiology Foundation/American Heart Association clinical guidelines based on the presence of hypertension, obesity, diabetes, metabolic syndrome, or prevalent atherosclerotic cardiovascular disease (ASCVD) at baseline.2 Physical activity was assessed at baseline using a modified Baecke questionnaire.

A total of 13,810 patients (54% women; 26% black) were included in the analysis. Recommended physical activity levels (ie, ≥75 min/week of vigorous activity or ≥150 min/week of moderate or vigorous activity) were achieved by 39% of participants, and 37% of participants reported poor levels of physical activity (ie, 0 min/week of moderate or vigorous activity). In this cohort, 49.9% of participants had hypertension, 26.5% had obesity, 11.1% had diabetes, 22.5% had metabolic syndrome, and 9.1% had prevalent ASCVD.


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Recommended levels of physical activity were reported by 34.8% of participants with hypertension, 29.4% of participants with obesity, 30.7% with diabetes, 38.8% with metabolic syndrome, and 39.6% with prevalent ASCVD. The adjusted incidence rates for heart failure in the overall study population were 10.2 per 1000 person-years for patients with poor physical activity, 8.8 per 1000 person-years for people with intermediate physical activity (ie, >0 min/week but below recommended levels), and 8.1 per 1000 person-years in patients with recommended levels of physical activity.

Over a median 26.0 years of follow-up, 2994 incident heart failure events occurred. Compared with participants outside of the respective high-risk group, diabetes (hazard ratio [HR], 3.14; 95% CI, 2.88-3.43), prevalent ASCVD (HR, 2.54; 95% CI, 2.30-2.80), metabolic syndrome (HR, 2.08; 95% CI, 1.91-2.26), obesity (HR, 2.04; 95% CI, 1.89-2.20), and hypertension (HR, 2.04; 95% CI, 1.89-2.21) were all associated with incident heart failure.

Higher levels of physical activity were associated with lower rates of incident heart failure in patients with hypertension, diabetes, obesity, and metabolic syndrome (P <.01 for all). There was no association between physical activity level and heart failure incidence in patients with prevalent ASCVD.

Participants who achieved recommended vs poor levels of physical activity were at lower risk for incident heart failure (HR, 0.78; 95% CI, 0.72-0.85) in multivariate analysis. This trend was observed in patients with hypertension (HR, 0.82; 95% CI, 0.73-0.91), obesity (HR, 0.82; 95% CI, 0.71-0.95), diabetes (HR, 0.72; 95% CI, 0.60-0.87), and metabolic syndrome (HR, 0.79; 95% CI, 0.69-0.92). There was no significant association between physical activity level and risk for incident heart failure in patients with prevalent ASCVD.

Recommended physical activity levels were associated with a lower prevalence of elevated high-sensitivity cardiac troponin T and N-terminal pro–brain natriuretic peptide in patients without ASCVD (P ≤.01 for both), but not in those with ASCVD.

Study limitations include its observational nature, given the potential for unmeasured confounding factors.

“[H]igher [physical activity] is associated with lower [heart failure] risk among several subgroups known to be at high risk for [heart failure], including patients with hypertension, obesity, diabetes mellitus, and metabolic syndrome,” the study authors concluded. “However, while [physical activity] is associated with reduced ASCVD risk and has multiple established cardioprotective benefits for patients with ischemic heart disease, it may be less effective in preventing [heart failure] once ASCVD is already established.”

References

  1. Florido R, Kwak L, Lazo M, et al. Physical activity and incident heart failure in high-risk subgroups: The ARIC study. J Am Heart Assoc. 2020;9(10):e014885. doi:10.1161/JAHA.119.014885
  2. Writing Committee Members, Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240‐e327. doi:10.1161/CIR.0b013e31829e8776