Abstract 19719: Physical Activity and Risk of Heart Failure With Preserved or Reduced Ejection Fraction in the Women’s Health Initiative Study
Background: Heart failure (HF) burden is large and growing among older women. Although physical activity (PA) has consistently been associated with lower HF risk in cohort studies, it is unclear whether the association differs in those having HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. We examined this relationship in a prospective cohort of postmenopausal women.
Methods: Participants were a subcohort of 39,974 women oversampled for African American and Hispanic ancestry and participation in the hormone trial who at baseline (1993-1998) were 50-79 years old and without known HF. Cases of HF were ascertained annually, and adjudicated using clinical records and ejection fraction to define HFpEF (EF >45%) or HFrEF (EF ≤45%). Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident HF in relation to self-reported total recreational PA, examined categorically (Inactive [referent] 0 MET-hr/wk, and incremental PA tertiles: >0-7.24, 7.25-17.0, >17.0 MET-hr/wk) and continuously (log MET-hr/wk) adjusting for study arm and baseline age, race-ethnicity, difficulty walking one block, sociodemographic factors and major clinical HF risk factors.
Results: There were 807 HFpEF cases and 508 HFrEF cases during 538,000 and 508,000 person-years follow-up, respectively. Compared to inactive women, HR (95% CI) for HFpEF across incremental PA tertiles were 0.99 (0.83, 1.19), 0.84 (0.68, 1.04) and 0.74 (0.59, 0.94) trend, p=0.003; and for HFrEF were 0.92 (0.73, 1.16), 0.73 (0.56, 0.96) and 0.82 (0.62, 1.08) trend, p=0.13. Additional adjustment for baseline history of CHD, atrial fibrillation, hormone therapy use, or cancer did not materially change these results. In the fully adjusted model, HR for HFpEF were 1.00, 0.97, 0.83, 0.74, trend p=0.004; and for HFrEF were 1.00, 0.90, 0.72, 0.82, trend p=0.16. Excluding women who reported inability to walk one block strengthened associations with HFpEF (HR = 1.00, 0.95, 0.76, 0.69, trend p=0.001) and HFrEF (1.00, 0.78, 0.60, 0.75, trend p=0.15).
Conclusion: Among postmenopausal women, higher self-reported total PA was associated with significantly lower risk of developing HFpEF, but not with risk of HFrEF.
Author Disclosures: C.B. Eaton: None. J.C. Larson: None. A.K. Chomistek: None. J.E. Manson: None. W. Li: None. C.E. Lewis: None. J.W. Bea: None. K.C. Johnson: None. J. Wactawski-Wende: None. M.J. LaMonte: None.
- © 2016 by American Heart Association, Inc.