Two large US studies published in a leading journal this month support the already substantial body of evidence that shows choosing to follow a healthy lifestyle helps prevent cardiovascular disease: one found it linked to lower risk of heart failure in men and the other found it linked to lower risk of high blood pressure in women.

Both studies are published in the July 22-29 issue of JAMA, the Journal of the American Medical Association.

For the first study, first author Dr Luc Djoussé, of the Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues used data covering 20,900 men taking part in the Physicians’ Health Study in the US and who were followed for an average of 22.4 years.

They found that following any one of six modifiable healthy lifestyle factors was linked to a lower lifetime risk of heart failure compared to not following any.

The six lifestyle factors were: maintaining a normal body weight, never smoking, taking regular exercise, drinking moderate amounts of alcohol, eating plenty of cereals, and eating plenty of fruits and vegetables.

The researchers also found that the more healthy lifestyle choices the men followed, the lower their lifetime risk of heart failure.

For example, the lifetime risk for heart failure was about 1 in 5 (21.2 per cent) for those men who didn’t follow any of the healthy lifestyle choices (ie they smoked, they were overweight, they did not have a diet rich in cereals, fruit and vegetables, and they did not take regular exercise). But for those who followed four or more healthy lifestyle choices, the lifetime risk was 1 in 10 (10.1 per cent).

The findings have major implications for public health, especially since heart failure is now known to be a leading cause of acute hospital admission and the most prevalent chronic cardiovascular condition, according a press statement made by the European Society of Cardiology (ESC).

In the second study, first author Dr John P. Forman, also from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues, used data covering more than 80,000 women taking part in the Nurses’ Health Study, described by the ESC as one of the “world’s landmark studies in women’s health epidemiology”.

All of the women’s blood pressure was normal (120/80 or less) and they were free of heart disease, diabetes, and cancer at the start of the study which followed them for 14 years.

The researchers found that following any one of six modifiable healthy lifestyle factors was linked to lower blood pressure.

The six modifiable lifestyle factors were: keeping to a normal BMI (under 25), exercising vigorously every day, following a heart-healthy diet, consuming a modest amount of alcohol, using non-narcotic pain relievers no more than once a week, and taking a folic acid supplement.

A heart-healthy diet was described as eating lots of fruits, nuts, legumes and other vegetables, whole grains, low fat dairy products, low sodium intake, and not consuming much red or processed meat or sugary drinks.

In this study too the researchers found a cluster effect: following all six lifestyle choices was linked to an 80 per cent lower risk of developing high blood pressure. Only 0.3 per cent of the women in the study followed all 6 lifestyle choices.

The ESC said this study also had important implications for public health.

ESC spokesman Professor Joep Perk from Oskarshamn District Hospital in Sweden, told the press that there wasn’t enough research on preventing poor health in women and called this study “an important piece of evidence”.

“The Nurses’ Health Study is an observational study, but because of the numbers involved I’m sure the results will be valid in broader female populations,” he added.

Talking about the 80 per cent reduction in risk of high blood pressure found in the women who followed all 6 lifestyle choices, Perk said this was like the findings of the Interheart study, the 2004 global study led by McMaster University in Canada.

That study found that 90 per cent of first heart attacks were linked to 9 lifestyle factors.

“So there’s a consistent pattern here,” said Perk, it suggests, he said, that:

“Four out of five cases of hypertension or heart attack are amenable to lifestyle intervention. So, most of us can do something about prevention.”

“It’s a public health issue, and we need to put our heads together,” he urged.

Perk said the two studies affirmed the ESC message on cardiovascular disease prevention:

  • Don’t smoke.
  • Exercise for at least 30 minutes every day.
  • Use calorie control and exercise to keep your BMI in the normal range.

BMI stands for Body Mass Index: it is the ratio of your weight in kilos to the square of your height in metres. A normal BMI is between 20 and 25. Thus a person who weighs 80 kilos (176 pounds) and stands 183 cm tall (6 feet) has a BMI of 23.9 which is in the normal range.

“These two studies yet again confirm the wisdom of this advice, and provide even more evidence to translate our knowledge into action” said Perk.

“Relation between modifiable lifestyle factors and lifetime risk of heart failure.”
Luc Djousse; Jane A. Driver; J. Michael Gaziano.
JAMA. 2009;302(4):394-400.

“Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women.”
John P. Forman; Meir J. Stampfer; Gary C. Curhan
JAMA. 2009;302(4):401-411.

Additional source: European Society of Cardiology.

Written by: Catharine Paddock, PhD