A new study out of Sweden evaluated prospectively how a few lifestyle modifications might yield significant reductions in risk of heart attacks. Published in the current Journal of the American College of Cardiology, the authors (based at the Karolinska Institute) followed almost 21,000 men, beginning in 1997, over the course of the next 12 years. The men, aged 45-79 at the study s outset, had no evidence or history of heart disease, cancer, hypertension, lipid/cholesterol abnormalities, or diabetes at baseline. The factors studied included diet, smoking, exercise, alcohol intake, and fatness (particularly abdominal).
The results were impressive: practicing just two of five low-risk behaviors -- a healthy diet and moderate alcohol consumption -- was associated with a relative risk of 0.65 a 35 percent reduction for heart attack (myocardial infarction, MI) compared with men who practiced none of the low-risk behaviors. And following all five low-risk factors -- refraining from smoking, being physically active and having no abdominal adiposity, in addition to the other two -- was associated with a relative risk of 0.14, meaning a risk reduction of 86 percent, wrote Agneta Ãkesson, PhD, the study s lead author. Unfortunately, they also point out that the combination of all 5 healthy behaviors would be expected to be present in about one percent of the population.
The authors defined the five low-risk behaviors as: being in the top quintile of the Recommended Food Score; consuming 10 to 30 g/day of alcohol; not smoking; walking or bicycling more than 40 minutes a day and exercising for at least an hour a week; and having a waist circumference of less than 95 centimeters (about 37 inches). The Healthy Food Score was developed for the National Health and Nutrition Examination Survey (NHANES), and is highly predictive of mortality. Points are given for servings per week of foods with beneficial effect on cardiovascular health, such as fruit, vegetables and whole grains, with a maximum score of 25. As told by the authors to MedPage Today, "This reduction in risk corresponded to 18% for the healthy diet, 11% for moderate alcohol consumption, 36% for no smoking, 3% for being physically active, and 12% for having a low abdominal circumference.
An accompanying editorial by Tufts University s School of Nutrition Science and Policy s Dariush Mozaffarian, MD, MPH, strongly endorses this approach to cutting the chance of heart attack. Mozaffarian noted that the Healthy Food Score is based on higher intake of healthful foods, rather than lower intake of unhealthful ones. These results are consistent, he said, with earlier analyses that found that a lack of healthful foods, rather than excess of unhealthful ones, produced a larger burden of disease.
ACSH s Dr. Gil Ross had this perspective: As we here at ACSH would expect, the most impactful modification was from not smoking, according to this well-constructed, large, prospective study. However, while certainly applauding these salutary goals, the authors may have underplayed the difficulties involved in attaining them. Quitting smoking in and of itself is a very difficult process; combining that with converting to healthier diet and exercise, weight loss to reduce abdominal girth, and moderating alcohol intake presents a daunting task. Even those accomplishing it have to continue down this straight-and-narrow path indefinitely well, at least over the course of the study s 12 years to reap the benefits. Still, noting the absence of medications for, e.g., high blood pressure and cholesterol, it s certainly worth a try.