People who make healthy lifestyle choices, including consuming a healthful diet, not smoking, maintaining a healthy weight, exercising regularly, and drinking moderately, have a lower risk of developing heart disease. A combination of these lifestyle habits cuts the risk of heart disease more dramatically than any single habit. But what about people who are taking medications to improve blood pressure or cholesterol levels? Does it matter if they adopt these habits?
A new study in the July 11, 2006 issue of Circulation found that a majority of coronary heart disease (CHD) events could be prevented if middle-aged and older men adopted multiple healthy lifestyle habits, even among those taking cholesterol or blood pressure lowering medications.
The participants included 42,847 healthy men who were part of the Health Professionals Follow-up Study, which followed male health professionals who were 40-75 years old when the study began in 1986. Researchers gathered information on the men’s current medical condition and lifestyle factors every two years for 16 years. They tracked which men developed CHD (ie, a nonfatal heart attack or dying from CHD) during the study. From this information, the researchers calculated a healthy lifestyle score for each man. The men could obtain scores of 0 (least healthy) to 5 (most healthy). The men got one point for each of the following lifestyle factors they adhered to:
During the study, 2,183 CHD events occurred. After adjusting for other factors associated with CHD (eg, age, family history, medication use), the researchers found that 62% of all CHD events may have been avoided if the men had adhered to all five lifestyle factors. Among the men who were taking blood pressure or cholesterol medications, the researchers calculated that 57% of CHD events may have been avoided by adopting the lifestyle factors.
The men who adopted two or more additional lifestyle factors over the course the study had a 27% lower risk of CHD, compared to men who adopted no additional lifestyle factors. Overall, each healthy lifestyle factor was significantly and independently associated with a reduced risk of CHD.
Since this study was observational (ie, the men chose to adopt or not adopt each of the factors), the researchers cannot say for sure that the lifestyle factors were the cause of the reduced risk of CHD. Ideally, a clinical trial would randomly assign certain men to the lifestyle factors, but this often is not feasible and can even be unethical (eg, randomizing men to smoke or not).
These findings suggest that many men may be able to avoid CHD by adopting a healthy lifestyle of not smoking, maintaining a healthy weight, exercising regularly, eating a healthful diet, and consuming alcohol in moderation. Importantly, these lifestyle factors also benefit men who are taking medication to control their blood pressure or cholesterol.
It may not be realistic for all men to adopt all of these habits. In this study, only 4% of the participants adhered to all five lifestyle factors. But the positive findings do provide some incentive to give it a try. And while blood pressure and cholesterol medications can reduce your risk of heart disease, they should never be considered a replacement for a healthy lifestyle.
RESOURCES:
American Heart Association
http://www.americanheart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov
References:
Chiuve SE, McCullough ML, Sacks FM, et al. 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.
Last reviewed July 2006 by Richard Glickman-Simon, MD
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