on July 3, 2006
Published online before print July 3, 2006, doi: 10.1161/CIRCULATIONAHA.106.621417
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Submitted on February 28, 2006
From the Departments of Nutrition (S.E.C., F.M.S., E.B.R.) and Epidemiology (E.B.R.), Harvard School of Public Health, Boston, Mass; the Cardiovascular Division (F.M.S.) and Channing Laboratory (F.M.S., E.B.R.), the Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and the Epidemiology and Surveillance Research Department, American Cancer Society, Atlanta, Ga (M.L.M.). * To whom correspondence should be addressed. E-mail: schiuve{at}hsph.harvard.edu.
Background--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. Methods and Results--We 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 Conclusions--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.
Revised on April 11, 2006
Accepted on May 8, 2006
Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men. Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications
Stephanie E. Chiuve ScD*,
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, we documented 2183 incident cases of CHD (nonfatal myocardial infarction and fatal CHD). In multivariate-adjusted Cox proportional hazards models, men who were at low risk for 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 no 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.
Key words: diet • lifestyle • risk factors • coronary disease • epidemiology
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Circulation 2006 114: 97.
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