The prevalence of heart failure increases with age, but a new prospective study has identified several modifiable factors that may lower the lifetime risk. In a cohort of 20,900 apparently healthy men (mean age 54 years) from Physicians’ Health Study I, incidence of new onset heart failure was tracked over a mean of 22 years follow-up. Healthy behaviors associated with lower risk of heart failure included regular exercise, moderate alcohol intake, maintaining normal body weight, not smoking, consumption of breakfast cereals, and consumption of fruits and vegetables (level 2 [mid-level] evidence). The estimated lifetime risk of heart failure was lowest, at 10.1%, in men with 4 or more of these beneficial lifestyle habits and highest, at 21.2%, in men with none of these habits (JAMA 2009 Jul 22;302(4):394).

These findings are limited by the study’s cohort design. The rate of hypertension at baseline was highest in the group with no healthy habits and lowest in the group with > 4 healthy habits. Although a similar benefit from healthy habits was noted in separate analyses of men with and without hypertension, potential biases from other group differences cannot be excluded.

In the same week in the New England Journal of Medicine, an editorial on healthcare reform calls for more investment in controlled trials comparing effectiveness of changes in lifestyle factors versus use of medications for prevention and treatment of medical illness (N Engl J Med 2009 Jul 23).