Background Many lifestyle-related risk factors for coronaryheart disease have been identified, but little is known abouttheir effect on the risk of disease when they are consideredtogether.
Methods We followed 84,129 women participating in the Nurses'Health Study who were free of diagnosed cardiovascular disease,cancer, and diabetes at base line in 1980. Information on dietand lifestyle was updated periodically. During 14 years of follow-up,we documented 1128 major coronary events (296 deaths from coronaryheart disease and 832 nonfatal infarctions). We defined subjectsat low risk as those who were not currently smoking, had a body-massindex (the weight in kilograms divided by the square of theheight in meters) under 25, consumed an average of at leasthalf a drink of an alcoholic beverage per day, engaged in moderate-to-vigorousphysical activity (which could include brisk walking) for atleast half an hour per day, on average, and scored in the highest40 percent of the cohort for consumption of a diet high in cerealfiber, marine n–3 fatty acids, and folate, with a highratio of polyunsaturated to saturated fat, and low in transfat and glycemic load, which reflects the extent to which dietraises blood glucose levels.
Results Many of the factors were correlated, but each independentlyand significantly predicted risk, even after further adjustmentfor age, family history, presence or absence of diagnosed hypertensionor diagnosed high cholesterol level, and menopausal status.Women in the low-risk category (who made up 3 percent of thepopulation) had a relative risk of coronary events of 0.17 (95percent confidence interval, 0.07 to 0.41) as compared withall the other women. Eighty-two percent of coronary events inthe study cohort (95 percent confidence interval, 58 to 93 percent)could be attributed to lack of adherence to this low-risk pattern.
Conclusions Among women, adherence to lifestyle guidelines involvingdiet, exercise, and abstinence from smoking is associated witha very low risk of coronary heart disease.
Source Information
From the Channing Laboratory (M.J.S., J.E.M., E.B.R., W.C.W.) and the Division of Preventive Medicine (J.E.M.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; and the Departments of Epidemiology (M.J.S., J.E.M., E.B.R., W.C.W.) and Nutrition (M.J.S., F.B.H., E.B.R., W.C.W.), Harvard School of Public Health — all in Boston.
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