After following older adults for more than 20 years, researchers found that dietary patterns were not as closely associated with developing heart failure as many might guess. However, patients had a lower risk for heart failure if they were physically active, had modest alcohol intake, did not smoke and were not obese.

Lead researcher Liana C. Del Gobbo, PhD, of the Harvard School of Public Health in Boston, and colleagues published their findings in the July edition of the Journal of the American College of Cardiology: Heart Failure.

“Our findings suggested that adherence to a few modifiable risk factors, including physical activity, moderate alcohol use, not smoking, and avoiding obesity, halved the risk of incident [heart failure] later in life,” they wrote. “Although overall dietary patterns were not associated with lower [heart failure] risk in this cohort, adherence to a healthy diet remains crucial for prevention of other cardiometabolic diseases, including hypertension, type 2 diabetes, and [coronary heart disease].”

They noted that heart failure-related costs in the U.S. in 2010 were $39.2 billion, and the condition was most prevalent in adults older than 65.

In this study, the researchers analyzed data from nearly 4,500 men and women in the Cardiovascular Health Study, which enrolled participants who were at least 65 in 1989 and 1990. Del Gobbo and colleagues assessed dietary patterns, physical activity, alcohol use, smoking history, body mass index (BMI) and waist circumference.

At baseline, the mean age was 72, while 61 percent of patients were women and 89 percent were Caucasians. Patients were excluded if they had heart failure or moderate and/or severe mitral or aortic regurgitation at baseline, missing information on lifestyle risk factors or implausible energy intake.

During a follow-up period of 21.5 years, there were 1,380 cases of heart failure. Del Gobbo et al found that smoking, modest alcohol intake, BMI and waist circumference were each associated with heart failure risk. They added that a walking pace faster than 3 miles per hour was associated with a 26 percent lower risk of heart failure and burning more than 845 kcal per week in physical activity led to a 22 percent lower risk of heart failure.

Participants with at least four of the healthy lifestyle factors had a 45 percent lower risk of heart failure, according to the authors.

For future studies, Del Gobbo and colleagues suggested researchers examine the effects of congenital defects, cardiomyopathies, drugs and/or toxins, renal dysfunction and genetic risk predictors.