Abstract 18949: Associations of Physical Activity Levels, Body Mass Index, and Risks of Heart Failure With Preserved Ejection Fraction vs. Reduced Ejection Fraction: An Individual-Level Pooled Analysis
Introduction: Low levels of physical activity (PA) and higher BMI have each been associated independently with risk of HF. However, it is unclear if this relationship is consistent for the two HF subtypes, HFpEF and HFrEF.
Methods: Individual-level data from three cohort studies WHI, MESA, and CHS were pooled and participants were stratified into guideline recommended categories of PA and BMI. Separate multivariable-adjusted Cox proportional hazards regression models were constructed to determine the association of BMI and PA level categories with risk of overall HF, HFpEF (EF >45%) and HFrEF (EF ≤ 45%) with land-marking of HF outcomes in the first 2 years of follow-up. Continuous associations between PA, BMI and outcomes were assessed using restricted cubic splines.
Results: A total of 51,498 participants with 2,834 HF events were included (1,248 HFpEF, 912 HFrEF, 674 HF events with missing EF). In adjusted analysis, there was a dose-dependent association between higher PA levels, lower BMI and risk of HF. Among HF subtypes, compared with no PA, higher levels of PA in any dose range were not associated with HFrEF risk. In contrast, for HFpEF, lower levels of PA (<500 MET-min/week) were not associated with HFpEF risk and dose-dependent associations with lower HFpEF risk were observed at higher levels (Figure A). PA at higher than guideline recommended (>1000 MET-min/week) levels were associated with 18% lower risk of HFpEF [HR (95% CI): 0.82 (0.69 – 0.98)]. The dose-response relationship for BMI with HFpEF risk was also stronger and more graded than with HFrEF risk such that increasing BMI above the normal range (> 25 kg/m2) was associated with greater increase in risk of HFpEF than HFrEF [Figure B].
Conclusion: In this pooled analysis, we found evidence of stronger and graded associations for PA and BMI with the risk of HF. Among HF subtypes, higher LTPA levels and lower BMI were more consistently and strongly associated with lower risk of HFpEF as compared with HFrEF.
Author Disclosures: A. Pandey: None. M. LaMonte: None. L. Klein: None. C. Ayers: None. B. Psaty: None. C. Eaton: None. N. Allen: None. J. De Lemos: Consultant/Advisory Board; Modest; Roche Diagnostics, Abbott Diagnostics. Research Grant; Significant; Abbott Diagnostics. Consultant/Advisory Board; Significant; Simen’s Health Care, Radiometer. M. Carnethon: None. P. Greenland: None. J. Berry: None.
- © 2016 by American Heart Association, Inc.