title: Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study.
abstract: BACKGROUND
  The impact of a healthy lifestyle on risk of heart failure (HF) is not well known.
  
  
  OBJECTIVE
  The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact.
  
  
  METHODS
  Participants were 84,537 post-menopausal women from the WHI (Women's Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology.
  
  
  RESULTS
  There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension.
  
  
  CONCLUSIONS
  An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts. Electronic address: gagha@hsph.harvard.edu.
authors.forename: Golareh
authors.initials: G
authors.lastname: Agha
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Loucks
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Tinker
authors.affiliation: Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Michaud
authors.affiliation: Ohio State University, College of Public Health, Columbus, Ohio.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D005247:Feeding Behavior; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D016387:Women's Health
keywords: cardiovascular diseases; heart failure; lifestyle; primary prevention; risk factors