Old-Fashioned Advice Rings True on Heart Disease and Women

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Amid the welter of often-conflicting diet and health advice, it can be difficult to figure out what constitutes a healthful diet and lifestyle -- especially when it comes to preventing heart disease. Should one go low-fat or avoid alcohol while doubling up on soy foods? How much exercise is enough, and should it be aerobic or strength training? A new report in the Archives of Internal Medicine (Akesson, A, et al., Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Arch Intern Med. 2007; 167:2122-2127) goes a long way towards clarifying some of the answers, and along the way supports what mainstream science has been telling us for years.

Akesson and colleagues at the Swedish Karolinska Institute used data provided by over 24,000 post-menopausal Swedish women (mean age was approximately 59) to ascertain their dietary patterns, activity levels, and other lifestyle factors (e.g., smoking, alcohol consumption). At the start of the study, all were free of cardiovascular disease and diabetes, and had not been diagnosed with cancer. The women's health status was followed for a little over six years.

Participants were divided into five groups, depending on the extent to which their diets and lifestyles approximated a "healthy dietary pattern" score. Those in the highest group (i.e, with the best dietary and lifestyle score) typically were the least likely to smoke, walked for more than forty minutes per day and exercised at least one hour per week, and on average drank about six grams of alcohol per day (for comparison, a standard drink of 5 oz. of wine, 12 oz. of beer, or 1.5 oz. of 80-proof distilled spirits contains 14 grams of alcohol). Compared to the other groups, these women ate twice as many vegetables, more fruits and slightly more red meat and whole grains. They also consumed more fiber, folate, vitamins C and E (a consequence of their high intake of vegetables, no doubt) than women in the other groups.

As one might expect, the risk of heart attacks in the group following the healthiest lifestyle compared to the group least compliant with these attributes was much lower -- by an astonishing 92%. Even when the most compliant group was compared with all the other groups combined, they still had a 78% lower risk of heart attacks.

Impressive as these results are, it's important to note that only about 5% of the women in the study actually had been adhering consistently to the lowest-risk lifestyle. The authors suggested that increasing the prevalence of such a lifestyle could substantially decrease the occurrence of heart attacks -- at least in post-menopausal women.

Ruth Kava, Ph.D., R.D., is Director of Nutrition at the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).