Higher levels of physical activity were associated with a lower risk of heart failure with preserved ejection fraction (HFpEF) in Black adults with subclinical myocardial injury, according to results from an observational study published June 9 in the Journal of the American College of Cardiology.

Kershaw V. Patel, MD, et al., assessed the independent and joint associations between physical activity and high-sensitivity cardiac troponin I (hs-cTnI) as a measure of subclinical myocardial injury with the risk of HFpEF and heart failure with reduced ejection fraction (HFrEF) among 3,959 Black adults participating in the Jackson Heart Study. At baseline, none of the participants had HF and the level of hs-cTnI and physical activity was measured in all. To evaluate associations between physical activity and hs-cTnI and the risk of HFpEF and HFrEF, adjusted Cox models were used.

Results showed that 25.1% of participants had subclinical myocardial injury and 48.2% were inactive. During the 12-year follow-up, HFpEF developed in 163 participants and HFrEF in 150 participants. On adjusted analysis, an association was found between higher hs-cTnI concentration (per 1-U log increase) and risk of HFpEF (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.25-1.72) and risk of HFrEF (HR, 1.57; 95% CI, 1.35-1.83). However, higher physical activity level (per 1-U log increase) was associated with a lower risk of HFpEF, but not HFrEF. In participants with subclinical myocardial injury, a significant interaction was found between hs-cTnI and physical activity for the risk of HFpEF (p interaction = 0.04), with those who were inactive, vs. those who were active, at higher risk of HFpEF.

"Among community-dwelling Black adults, physical inactivity and subclinical myocardial injury are each independently associated with higher risk of HFpEF," the authors conclude. "Physically active adults with subclinical myocardial injury have similar risk of HFpEF as those who were active with no subclinical myocardial injury." They note that moving forward, studies are needed to evaluate the impact of physical activity on longitudinal changes in subclinical myocardial injury to evaluate whether targeted lifestyle interventions can prevent HFpEF.

In a related editorial comment, Carl J. Lavie, MD, FACC, et al., write that "interventions to reduce obesity, physical inactivity and sedentary behavior, and HF – especially HFpEF – are desperately needed in modern society, and this is more strongly highlighted in the [African American] population, as demonstrated in this Jackson Heart Study."

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Heart Failure, Sedentary Behavior, Troponin I, African Americans, Stroke Volume, Proportional Hazards Models, Confidence Intervals, Independent Living, Follow-Up Studies, Exercise, Ventricular Dysfunction, Left, Longitudinal Studies, Obesity

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