Healthy Lifestyle Linked to 80% Less Hypertension and 90% Lower Lifetime Risk of Heart Failure

In one study, led by Dr. John P. Forman (Brigham and Women’s Hospital, Boston, MA), women who maintained a normal weight, exercised daily, ate a diet that was high in fruits, vegetables, and low-fat dairy products and low in salt, and took a daily folic-acid supplement had a significantly lower incidence of self-reported hypertension.⁽¹⁾

 

In the other, led by Dr. Luc Djoussé (Brigham and Women’s Hospital), men who exercised regularly, drank moderately, did not smoke, were of normal weight, and ate a diet that included cereal, fruits, and vegetables had a lower lifetime risk of heart failure.⁽²⁾

 

The public-health message from these two studies is particularly timely, said Dr. Rene Alvarez (University of Pittsburgh Medical Center, PA). “These are pretty important papers. These are modifiable risk factors, that’s the key, and if you can modify these risk factors when you are healthy, then you are going to have an important impact on your health long term.”

 

Forman and his colleagues looked at the link between low-risk lifestyle factors and the risk of developing hypertension in 83,882 women age 27 to 44 years in the second Nurses’ Health Study who did not have hypertension, cardiovascular disease, diabetes, or cancer and who had normal reported blood pressure as defined as systolic blood pressure of <120 mm Hg and diastolic blood pressure of <80 mm Hg in 1991; they were followed for 14 years through 2005.

 

The researchers identified the following six variables associated with reduced risk of hypertension: body-mass index (BMI) less than 25; 30 minutes a day of vigorous exercise; a high score on the Dietary Approaches to Stop Hypertension (DASH) diet based on responses to a food frequency questionnaire; modest alcohol intake; use of nonnarcotic analgesics less than once per week; and intake of 400 µg/day or more of supplemental folic acid. A DASH score was determined based on high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of sodium, sweetened beverages, and red and processed meats.

 

During the 14 years of follow-up, 12,319 new cases of hypertension were reported. After adjustment for age, race, family history of hypertension, smoking status, and the use of oral contraceptives, all six modifiable risk factors were independently associated with the risk of developing hypertension. Women who had all six low risk factors — which amounted to 0.3% of the study cohort, had about an 80% lower risk of developing high blood pressure.

 

BMI alone was the most powerful predictor of hypertension, with a BMI of 25 or greater having an adjusted population-attributable risk (PAR) of 40% compared with a BMI of less than 25.

 

Forman stated that, “The public-health toll from high blood pressure is staggering.” “Individuals and society have the power and responsibility, by modifying diet, lifestyle, and behaviors, to hypothetically prevent to a large degree the development of a disease that takes a drastic toll on public health.”

 

Djoussé and his colleagues analyzed data on 20,900 men from the Physicians’ Health Study I (1982–2008). Their mean age at baseline was 54 years, and all were apparently healthy. Similarly to the previous study, the investigators assessed the following modifiable lifestyle factors for their link to the lifetime risk of heart failure: body weight; smoking; exercise; alcohol intake; consumption of breakfast cereals; and consumption of fruits and vegetables.

 

During a mean follow-up of 22.4 years, 1,200 men developed heart failure. The overall lifetime risk of heart failure was 13.8% (95% CI 12.9% — 14.7%) at age 40 years and remained constant through age 70 years. At age 80 years, the lifetime risk reached 10.6% (95% CI 9.4% — 11.7%).

 

Men with hypertension had a higher lifetime risk of heart failure than those who did not have hypertension.

 

With regard to the modifiable risk factors, these were individually and jointly associated with a lower lifetime risk of heart failure. Men who did not adhere to any of the six lifestyle factors had the highest risk of developing heart failure in their lifetime — 21.2% (95% CI 16.8% — 25.6%); whereas in men who adhered to four or more desirable lifestyle factors, their risk was only 10.1% (95% CI 7.9% — 12.3%).

 

Djoussé stated that, “The take-home message for general practitioners and cardiologists is that it is important to recommend and encourage healthy behaviors because they really do make a difference.… Avoid smoking completely, keep a healthy weight, and do regular exercise. These are key. If you have these three under control, then your lifetime risk of heart failure is cut substantially. This is just as important as prescribing aspirin and lipid-lowering drugs. Make sure your patients know how important these lifestyle factors are — they are just as important as medication.”

 

In an accompanying editorial, Dr. Veronique L. Roger (Mayo Clinic, Rochester, MN) writes that, “The studies by Forman et al and Djoussé et al underscore that healthy lifestyle will help prevent cardiovascular disease and greatly enhance health, which is a compelling reminder that health is the shared responsibility of individuals and communities. This in turn implies that public-health policies and clinical care must join forces to achieve effective disease prevention.”

 

1.                                Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401-411.

2.                                Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009; 302:394-400.