Abstract Body: Introduction: Heart failure (HF) morbidity and mortality are disparately greater among Black individuals compared with their peers from other racial and ethnic backgrounds. Sleep, physical activity (PA), and sedentary behavior (SB) are each associated with incident HF, but these are interdependent behaviors, and integration of these exposures is needed to best understand the holistic risk for HF. Therefore, we examined the association between 24-hour compositional distribution of these behaviors and incident HF, including HF subtypes (i.e., HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]).

Methods: Black adults (N=5,306) aged 21-84 years old residing in the Jackson, MS metropolitan area were recruited to join the Jackson Heart Study (JHS) between 2000-2004 (baseline), with additional examinations 2005-2008 and 2009-2013. At baseline, usual nightly hours of sleep were self-reported using the JHS Sleep History Form, PA was collected via the JHS Physical Activity Cohort survey, and SB was calculated as the remainder of the 24 hours. Individuals with HF or a history of HF before 2005, the start of HF surveillance, were excluded. Events of incident HF, and HF subtypes, were assessed annually through 2016. Cox proportional hazard regression was used to estimate the association between the composition of 24-hour movement behavior and the risk of each outcome. Models were adjusted for baseline age, sex, education, body mass index, smoking status, diabetes, hypertension, chronic obstructive pulmonary disease, coronary heart disease, and chronic kidney disease.

Results: Participants (n=4,102) included 64% females and had a mean (SD) age of 54.5 (12.5) years. The cumulative incidence of HF was 8.1% (311 events) over a mean follow-up of 10.5 years. Most of the 24-hour day was SB (71.7%), followed by sleep (26.6%) and PA (1.7%). The proportion of time spent in PA, relative to the remaining movement behaviors, was associated with a lower risk of incident HF (0.88 [0.81, 0.95]) and HFpEF (0.86 [0.77, 0.96]). There was no association between PA and the risk of incident HFrEF. Neither the proportion of sleep nor SB, relative to the remaining movement behaviors, was associated with the risk of HF or HF subtypes.

Conclusions: Among Black adults in the JHS, higher PA, relative to SB and sleep, was associated with a lower risk of incident HF and HFpEF. Promotion of habitual PA over the 24-hour cycle may reduce the risk of HF.