Healthy Lifestyle and Risk of Heart Failure: Results From 2 Prospective Cohort Studies

Susanna C Larsson, Thanasis G Tektonidis, Bruna Gigante, Agneta Åkesson, Alicja Wolk

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


BACKGROUND: The joint impact of multiple healthy lifestyle factors on heart failure (HF) risk is unclear. We investigated the separate and collective associations of healthy lifestyle factors with HF incidence in 2 population-based prospective cohort studies.

METHODS AND RESULTS: This study consisted of 33,966 men (Cohort of Swedish Men) and 30,713 women (Swedish Mammography Cohort) who were 45 to 83 years of age and free of HF and ischemic heart disease at baseline. A healthy lifestyle was defined as being a nonsmoker and physically active (≥150 min/wk), and having body mass index between 18.5 and 25 kg/m(2) and a healthy diet (defined as adherence to a modified Mediterranean diet). Incident HF cases were ascertained by linkage with the Swedish National Patient Register and the Swedish Cause of Death Register. Cox proportional hazards regression was used to analyze the data. During 13 years of follow-up, HF was diagnosed in 1488 men and 1096 women. Each healthy lifestyle factor was associated with a statistically significant lower risk of HF in both men and women, and the risk decreased with increasing number of healthy behaviors. The greatest reduction in HF risk was observed for combinations that included nonsmoking. Compared with men and women with none of the healthy lifestyle factors, the multivariable relative risks (95% confidence interval) of HF for those with all 4 healthy behaviors were 0.38 (0.28-0.53) in men and 0.28 (0.19-0.41) in women.

CONCLUSIONS: Adhering to a healthy lifestyle is associated with a substantially lower HF risk.

CLINICAL TRIAL REGISTRATION: URL: Unique identifiers: NCT01127698 and NCT01127711.

Original languageEnglish
Pages (from-to)e002855
JournalCirculation: Heart Failure
Issue number4
Publication statusPublished - Apr 2016


  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Diet, Mediterranean
  • Female
  • Health Behavior
  • Health Knowledge, Attitudes, Practice
  • Heart Failure/diagnosis
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Middle Aged
  • Motor Activity
  • Multivariate Analysis
  • Proportional Hazards Models
  • Prospective Studies
  • Protective Factors
  • Registries
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Smoking/adverse effects
  • Smoking Prevention
  • Sweden/epidemiology
  • Time Factors


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