Sedentary Behavior, Weight Gain Can Increase Heart Failure Risk

Physical inactivity and weight gain may increase the risk of heart failure with preserved ejection fraction.

Physical activity and maintaining a healthy weight are factors known to improve overall health, including the prevention of diseases such as cancer and heart disease. In a study published by the Journal of the American College of Cardiology, researchers discovered a link between physical inactivity, weight gain, and a subtype of heart failure that currently has no drug therapy options.

Heart failure is a condition where the heart cannot pump enough oxygenated blood to support bodily function. Patients with heart failure can experience shortness of breath, fatigue, swollen legs, and quickened heartbeat. Subtypes of the condition include heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

"Previous studies have consistently found an association between low levels of physical activity, high BMI, and overall risk of heart failure, but this study shows that the association is more pronounced for heart failure with preserved ejection fraction, the type of heart failure that is the most challenging to treat," said senior study author Jarett Berry, MD.

In patients with HFpEF, the heart stiffens, and resists expansion. In simple terms, hearts with HFpEF do not relax enough, and hearts with HFrEF do not squeeze enough. While there are many treatment options for HFrEF, there are no evidence-based treatments for HFpEF, according to the study.

“The 5-year survival rate among heart failure with preserved ejection fraction patients is around 30 to 40%,” said first author of the stuy Ambarish Pandey, MD. “While heart failure with reduced ejection fraction survival has improved significantly over the years, heart failure with preserved ejection fraction prognosis is little changed.”

Included in the study were 51,000 participants from the Women’s Health Initiative, the Multiethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Of the participants, 3180 developed heart failure, with 39% of patients diagnosed with HFpEF, 29% diagnosed with HErEF, and 32% unclassified cases.

The investigators discovered that cases of HFpEF were 19% lower among patients who met exercise recommendations, according to the study. The study authors noted that high body mass index was observed to be strongly associated with HFpEF than HFrEF.

Since there are no approved evidence-based treatments for HFpEF, its growing incidence among elderly women is particularly concerning.

ACE inhibitors, beta blockers, and aldosterone antagonists have shown efficacy in reducing mortality among patients with HFpEF. However, clinical trials have failed to find a medication that reduces mortality among patients with HFrEF.

Unfortunately, the only treatment option available to patients with HFrEF is a heart transplant, which can be strenuous on the elderly. Therefore, preventing heart failure is key, and may be successfully achieved by increasing physical activity and preventing weight gain.

"These findings highlight the importance of lifestyle interventions such as increasing physical activity levels and reducing weight to combat the growing burden of this disease," Dr Berry concluded.