A healthy lifestyle that includes diet, exercise, and not smoking can significantly reduce women's risk for heart disease, according to this study recently published in the New England Journal of Medicine. While studies show that diet and lifestyle reduce one's risk for heart disease, most studies look at individual risk factors, not total lifestyle. Unlike these others studies, this study assessed the effect of a combination of lifestyle practices, including diet, on the risk for heart disease.

Researchers followed over 84,000 women participating in the Nurses' Health Study for 14 years. All participants completed follow-up questionnaire every 2 years. Each questionnaire provided information about weight, exercise, cigarette smoking, menopausal status, physician-diagnosed hypertension and high cholesterol levels. Participants also completed food-frequency questionnaires to report their dietary intake.

Five lifestyle and dietary factors were studied - smoking, exercise, diet, alcohol intake and body mass index (BMI; weight compared to height). For each of these variables, a "low-risk" group was established.

• had stopped smoking or never smoked
• consumed 5 g of alcohol or more a day
• undertook vigorous activity, which included brisk walking, for an average of at least a half-hour daily
• had body-mass index of 25 or less
• had a dietary score in the "highest" (or best) 40%. The score was a combined measure based on a diet that was low in trans-fats and glycemic load (the amount that diet raises blood sugar); high in cereal fiber, marine n-fatty acids and folate; and with a high ratio of polyunsaturated to saturated fats.

To get the best estimate of long-term dietary intake and physical activity an average of all previous information was used. For the other factors, the most recent information provided was used. The researchers did not estimate the effect of medications, hormone use, or medical condition, but they adjusted for these in their analyses.

During the 14 years of follow-up, there were over 1,000 heart disease events - in fact, 832 heart attacks and 296 deaths from heart attacks. There were also 705 strokes. Smoking was the single most important risk factor for such events. Women who smoked 15 or more cigarettes a day were 5.48 times more likely to have a cardiac event than non-smokers. And women who smoked only 1 to 14 cigarettes a day were still 3.12 times as likely to have an attack.

Women in the Low-Risk Category for all five of the risk factors listed above had an 83% lower risk compared to the other women. Those in the Low-Risk Category for four of the five risk factors had 66% less risk, and those with low-risk for three of five had 57% less risk.

A separate analysis of those women who were not currently smoking and were in the low-risk category for the other four risk factors showed that 74% of the heart disease events in non-smoking women might be prevented if they fall in a low-risk category for the other four risk factors.

The researchers conclude their report as follows: "Among women, adherence to lifestyle guidelines involving diet, exercise and abstinence from smoking is associated with a very low risk of coronary heart disease."

This study underscores the importance of looking at the "big-picture", instead of just smoking, or diet, or exercise. While regular exercise is important, one also needs to follow a low-fat diet with plenty of enriched whole grains, fruits and vegetables, low-fat dairy products, and lean meats, poultry and fish. Your primary care provider can direct you to a registered dietitian, fitness trainer or other qualified health professional to help you assess your total lifestyle and to make changes, as needed.

Source

Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle.
MJ. Stampfer, FB. Hu, JE. Manson,  et al., N Engl J Med, 2000, vol. 343, pp. 16--22

Links

• How
  to start exercising
• When you stop
  smoking