Physical Activity and Incident Heart Failure in High‐Risk Subgroups: The ARIC Study

Background Greater physical activity (PA ) is associated with lower heart failure (HF ) risk. However, it is unclear whether this inverse association exists across all subgroups at high risk forHF , particularly among those with preexisting atherosclerotic cardiovascular disease.Methods and Results We followed 13 810ARIC (Atherosclerosis Risk in Communities) study participants (mean age 55 years, 54% women, 26% black) withoutHF at baseline (visit 1; 1987–1989).PA was assessed using a modified Baecke questionnaire and categorized according to American Heart Association guidelines: recommended, intermediate, or poor. We constructed Cox models to estimate associations betweenPA categories and incidentHF within each high‐risk subgroup at baseline, with tests for interaction. We performed additional analyses modeling incident coronary heart disease as a time‐varying covariate. Over a median of 26 years of follow‐up, there were 2994HF events. Compared with poorPA , recommendedPA was associated with lowerHF risk among participants with hypertension, obesity, diabetes mellitus, and metabolic syndrome (allP <0.01), but not among those with prevalent atherosclerotic cardiovascular disease (coronary heart disease, stroke, or peripheral arterial disease) (hazard ratio, 0.91; 95%CI , 0.74–1.13 [P interaction=0.02]). RecommendedPA was associated with lower risk of incident coronary heart disease (hazard ratio, 0.79; 95%CI , 0.72–0.86), but not with lowerHF risk in those with interim coronary heart disease events (hazard ratio, 0.90; 95%CI , 0.78–1.04 [P interaction=0.04]).Conclusions PA was associated with decreasedHF risk in patients with hypertension, obesity, diabetes mellitus, and metabolic syndrome. Despite a myriad of benefits in patients with atherosclerotic cardiovascular disease,PA may have weaker associations withHF prevention after ischemic disease is established.