Excess Weight, Inactivity Increase Heart Failure Risk In Men
Staying lean and fit can dramatically lower the risk of heart failure in men, researchers report in Circulation: Journal of the American Heart Association.
In the Physicians’ Health Study, researchers from the Brigham and Women’s Hospital in Boston, followed 21,094 U.S. male physicians, 40 to 84 years old, for 20 years and found:
• Lean and active men had the lowest risk for heart failure and obese and inactive men had the highest risk.
• After adjusting for risk factors such as high blood pressure, diabetes and high cholesterol, the risk of heart failure increased by 49 percent in overweight men and 180 percent in obese men compared with lean participants.
• Any amount of vigorous physical activity that caused sweating, ranging from a low of one to three times a month to a high of five to seven times a week, was associated with an 18 percent reduction in heart failure risk, after adjusting for other known causes of heart failure.
• Compared with men who rarely or never vigorously exercised, men engaging in vigorous physical activity five to seven times a week had a 36 percent reduction in heart failure risk.
• Compared with participants who were lean and active, the risk of heart failure increased 19 percent in the lean and inactive; 49 percent in the overweight and active; 78 percent in the overweight and inactive; 168 percent in the obese and active; and 293 percent in the obese and inactive.
“Whereas previous studies have established that obese men have a higher likelihood of developing heart failure, the present investigation has extended this knowledge by pointing out that even overweight or pre-obese men are not spared from this increased risk,” said Satish Kenchaiah, M.D., M.P.H., lead author of the study and investigator at the Physicians’ Health Study, Brigham and Women’s Hospital. “On average, in men who are 5 feet 10 inches tall, for every 7 pounds of excess body weight, the risk of heart failure will go up by 11 percent over the next 20 years”
The study took place from 1982 to 2007, and participants completed questionnaires about demographics, lifestyle and medical history twice in the first year and annually thereafter. The physicians reported height and weight, which was used to calculate body mass index (BMI).
Men with BMI less than 25 were considered lean, 25 to 29.9 was overweight, and greater than 30 was obese. Physical activity was based on activity that worked up a sweat with options of rarely/never, one to three times a month, once a week, two to four times a week, five to six times a week or daily. Men who said they rarely/never exercised were considered inactive. Those who said they exercised one to three times a month or more were considered active.
About 40 percent of the participants were overweight and about 5 percent were obese at baseline. A greater proportion of obese men exercised less. Participants who rarely or never exercised were older, had higher BMI, smoked cigarettes more often and had a greater prevalence of high blood pressure and diabetes. During follow-up, 1,109 of 21,094 physicians developed heart failure.
“Another interesting finding of our study is that BMI and vigorous physical activity did not influence each other’s effect on the risk of heart failure,” Kenchaiah said. “Higher BMI increased the risk of heart failure in inactive as well as active individuals. By the same token, the beneficial effect of vigorous physical activity in reducing the risk of heart failure was observed in lean, overweight, and also obese men.”
About 67 percent of Americans have excess body weight and only about 30 percent exercise regularly, he said. “Each year about 660,000 Americans are newly diagnosed with heart failure. Once heart failure develops, the quality of life deteriorates, and about 80 percent of the men and 70 percent of the women <65 years with heart failure die within eight years.”
About 1 million hospitalizations and 3 million outpatient and emergency visits are attributed to heart failure in the United States each year, with estimated costs for 2008 at $35 billion, he said.
“Adopting a healthy lifestyle, keeping a normal weight, and exercising regularly will go a long way toward reducing one’s risk of heart failure and, in turn, the population burden of heart failure,” Kenchaiah said. “Both staying lean and being fit go hand in hand.”
Future studies should focus on the types of physical activity, total energy expenditure and the types of obesity that influence heart failure risk, he said. “Importantly, clinical trials targeting weight reduction and exercise level on the risk of heart failure will likely provide definitive answers.”