Coronary artery disease
Usefulness of Desirable Lifestyle Factors to Attenuate the Risk of Heart Failure Among Offspring Whose Parents had Myocardial Infarction Before Age 55 Years

https://doi.org/10.1016/j.amjcard.2012.03.028Get rights and content

Heart failure (HF) is one of the leading causes of hospitalization and death in the United States and throughout Europe. Although a higher risk for HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MIs before age 55 years, it is unclear whether adherence to healthful behaviors can mitigate that risk. The aim of the present study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence from smoking can attenuate such increased HF risk. Information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to ≥3 healthy lifestyle factors were classified as having good versus poor lifestyle scores. Incident HF was assessed via yearly follow-up questionnaires and validated in a subsample. During an average follow up of 21.7 ± 6.5 years, 1,323 new HF cases (6.6%), of which 190 (14.4%) were preceded by MI, occurred. Compared to subjects with good lifestyle scores and no parental histories of premature MI, multivariate adjusted hazard ratios for incident HF with antecedent MI were 3.21 (95% confidence interval 1.74 to 5.91) for subjects with good lifestyle score and parental histories of premature MI, 1.52 (95% confidence interval 1.12 to 2.07) for those with poor lifestyle score and no parental histories of premature MI, and 4.60 (95% confidence interval 2.55 to 8.30) for those with poor lifestyle scores and parental histories of premature MI. In conclusion, our data suggest that even in subjects at higher risk for HF because of genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk.

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Methods

The Physicians' Health Study (PHS) I is a completed randomized, double-blind, placebo-controlled trial designed to study the effects of low-dose aspirin and β-carotene on cardiovascular disease and cancer in United States male physicians. In 1997, a second randomized trial, PHS II, was started and included 7,641 physicians from PHS I along with 7,000 new physicians. Detailed descriptions of PHS I and PHS II have been published elsewhere.1, 2 Participants from PHS I, including the 7,641 subjects

Results

Among 20,060 participants in PHS I, the mean age at 12 months after randomization was 55 ± 9.5 years. Table 1 lists baseline characteristics of the study participants. Although 94% of the subjects did not report parental histories of premature MI, 6% of the participants had ≥1 parent who had an MI before the age of 55 years. In addition, 60% of the subjects had good lifestyle scores. Subjects with parental histories of premature MI were noted to be younger than those with no parental histories

Discussion

Our findings demonstrate that in the presence of parental history of premature MI, adherence to healthful lifestyle factors was associated with a lower risk for HF with antecedent MI. Our data suggest that the influence of healthful lifestyle factors on this association might be stronger at younger compared to older ages.

Genetic factors have been demonstrated to play an important role in the development of HF.6, 7 Several important HF predictors have also been shown to have a strong genetic

Acknowledgment

We are indebted to the participants in the PHS for their outstanding commitment and cooperation and to the entire PHS staff for their expert and unfailing assistance.

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      This result may relate to the present meta-analysis indicating that a high proportion of mortality might be explained by incident CVD. Moreover, the present results are in accordance with other studies that could not be included in the present analyses because of the lack of an appropriate risk estimate for the whole study population: Having a low healthy lifestyle score (score zero to two) among those with a parental history of premature MI was associated with a MI risk of 4.60 (95% CI=2.55, 8.30) compared with participants with a high lifestyle score (score three to four) and without parental history of premature MI.37 Moreover, a study pooling three large cohort studies showed that adherence to a healthy lifestyle decreases the risk of coronary events and subclinical burden of coronary artery disease in all genetic risk categories suggesting that a healthy lifestyle is advantageous for all individuals even with a high genetic risk of CHD.38

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    This study was supported by Grants R01 HL092946 and HL092946-S1 (to Dr. Djoussé) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. The Physicians' Health Study is supported by Grants CA-34944, CA-40360, and CA-097193 from the National Cancer Institute and Grants HL-26490 and HL-34595 from the National Heart, Lung, and Blood Institute.

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