The association between modifiable lifestyle factors (body weight, smoking, exercise, alcohol intake, consumption of breakfast cereals and consumption of fruits and vegetables) and the lifetime risk of heart failure (HF) was examined in a large cohort of men (mean age 53.6 years) from the Physicians’ Health Study I. Among the 20 900 participants and over the mean follow-up of 22.4 years, the lifetime risk of HF at 40 years of age was 13.8% (approximately 1 out of 7 subjects) (95% confidence interval (CI), 12.9% -14.7%). This risk remained constant among men who remained free of HF through age 70 and then reached 10.6% (95% CI, 9.4% -11.7%) at age of 80 years. Risk of HF was 2% to 4% higher in men with hypertension. Body weight, smoking, exercise, alcohol intake, consumption of breakfast cereals and consumption of fruits and vegetables were individually associated with a lower lifetime risk of HF. For instance, the lifetime risk of HF was approximately 1 in 5 (21.2%; 95% CI, 16.8% - 25.6%) among men not adhering to these lifestyle factors compared to 1 in 10 (10.1%; 95% CI, 7.9% - 12.3%) among those adhering to 4 or more healthy lifestyle factors. Thus, in apparently healthy men, adherence to a healthy lifestyle is associated with lower lifetime risk of HF. These findings highlight the importance of prevention strategies. In an accompanying editorial, Roger discusses the significance of the conclusions of this study as to the importance of a healthy lifestyle to reduce cardiovascular disease. Adherence to a healthy lifestyle is a shared responsibility of individuals and communities and thus health policies and clinical care should join forces to develop effective disease prevention strategies.
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