Can we prevent heart failure with exercise?

Although important gains have been made in the treatment of heart failure with pharmacological and device therapies, there is a need for new approaches that are safe and effective, particularly in the elderly. Targeting patients with stage A heart failure, those at high risk of developing clinical heart failure but without detectable structural heart disease, is a worthwhile strategy (2). Lifestyle interventions, such as xercise, are especially appealing because they can be peronalized, are cost-effective, and carry an intuitive appeal. In this issue of the Journal, DeFilippi et al. (3) report an nalysis of 2,933 participants in the CHS (Cardiovascular ealth Study) composed of older adults (65 years of age and lder) who were free of heart failure at study onset. -terminal pro–B-type natriuretic peptide (NT-proBNP) nd cardiac troponin T levels were measured at baseline and to 3 years later. Available data on self-reported physical ctivity and walking pace were developed into a previously alidated composite activity score. The investigators found hat the probability of significant increases in both bioarker concentrations between baseline and follow-up visits as inversely related to physical activity scores. Compared ith participants with the lowest score (worst), those with he highest activity scores (best) had half the risk of an ncrease in NT-proBNP (odds ratio: 0.50; 95% confidence nterval: 0.33 to 0.77) and a third of the risk of an increase n cardiac troponin T (odds ratio: 0.30; 95% confidence