The authors state that healthy lifestyle choices such as eating a prudent diet, exercising regularly, managing weight, and not smoking may substantially reduce coronary heart disease (CHD) risk by improving lipids, blood pressure, and other risk factors. The burden of CHD that could be avoided through adherence to these modifiable lifestyle factors has not been assessed among middle-aged and older US men, specifically men taking medications for hypertension or hypercholesterolemia. The authors prospectively monitored 42,847 men in the Health Professionals Follow-up Study, 40 to 75 years of age and free of disease in 1986. Lifestyle factors were updated through self-reported questionnaires. Low risk was defined as (1) absence of smoking, (2) body mass index < 25 kg/m2, (3) moderate-to-vigorous activity ≥ 30 min/d, (4) moderate alcohol consumption (5 to 30 g/d), and (5) the top 40% of the distribution for a healthy diet score.
Over 16 years, the investigators documented 2,183 incident cases of CHD (nonfatal myocardial infarction and fatal CHD). In multivariate-adjusted Cox proportional hazards models, men who were at “low risk” according to all 5 lifestyle factors had a lower risk of CHD (relative risk: 0.13; 95% confidence interval [CI]: 0.09, 0.19) compared with men who were at low risk for none of the lifestyle factors. Sixty-two percent (95% CI: 49%, 74%) of coronary events in this cohort may have been prevented with better adherence to these 5 healthy lifestyle practices. Among men taking medication for hypertension or hypercholesterolemia, 57% (95% CI: 32%, 79%) of all coronary events may have been prevented with a low-risk lifestyle. Compared with men who did not make lifestyle changes during follow-up, those who adopted ≥ 2 additional low-risk lifestyle factors had a 27% (95% CI: 7%, 43%) lower risk of CHD. The authors conclude that a majority of CHD events among US men may be preventable through adherence to healthy lifestyle practices, even among those taking medications for hypertension or hypercholesterolemia
Curtis Ellison of the Boston University School of Medicine comments “this paper is another of several recent reports on a “healthy lifestyle” (that includes the 5 components listed in the first paragraph of the summary). Adjusting for the other factors, in comparison with the moderate drinkers (5-30 g of alcohol/day, from slightly below 0.5 of a drink to about 2.5 drinks/day), non-drinkers had 37% higher risk of CHD, while current smokers had 2 to 3 times higher risk for CHD than never smokers. Obesity (BMI ≥ 30) was associated with more than 50% greater risk of CHD; the effects of exercise and diet were less marked. The results were similar for men who were on medication for hypertension and/or hyperlipidemia. The authors calculated that 62% of all CHD cases were attributable to the lifestyle factors studied; thus, they conclude that the majority of cases of CHD may be attributed to poor adherence to a healthy lifestyle”.
Source: Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men- benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation 2006;114:160-167. http://www.alcoholconcern.org.uk/servlets/wrapper