High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

Heart failure (HF) is a cardiovascular disease (CVD) outcome that is associated with high morbidity and mortality as well as high healthcare costs.1 Given that HF is the end stage of most CVDs, both conditions share common risk factors such as type 2 diabetes (T2D), hypertension, smoking and obesity.2 Socioeconomic status (SES) has been recognized to have a measurable and significant effect on cardiovascular health. It has been reported that low SES may confer a cardiovascular risk that is equivalent to conventional risk factors.3 Low SES has been shown to be a powerful and independent predictor of HF development and adverse outcomes.4 Biological, behavioural and psychosocial risk factors prevalent in socioeconomically deprived individuals are known to accentuate the relationship between low SES and cardiovascular outcomes such as HF.3 These include lower levels of education, unhealthy lifestyles such as excessive alcohol consumption, limited access to health care and higher prevalence of comorbid conditions.