Chiuve SE et al. (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. Circulation 114: 160–167

Certain risk factors for coronary heart disease (CHD), such as hypercholesterolemia, hypertension and smoking, can be modified through lifestyle changes. Chiuve et al. investigated the CHD burden that may be prevented if individuals adhere to a healthy lifestyle.

The study used data from 42,847 men in the Health Professionals Follow-up Study, who were aged 40–75 years and free from chronic disease at baseline in 1986. Questionnaires every 2–4 years collected data on smoking status, BMI, activity level, diet, and alcohol consumption. For each factor, individuals scored 1 point if they met the criteria for low risk (i.e. not currently smoking, BMI <25 kg/m2, moderate to vigorous activity for ≥3.5 h/week, healthy diet score in top 40%, and moderate alcohol consumption of 5–30 g/day) and 0 points otherwise. Healthy lifestyle scores were calculated by totaling the number of low-risk lifestyle factors, and therefore ranged from 0 (least healthy) to 5 (most healthy).

Over 16 years of follow-up, 2,183 cases of incident CHD, defined as nonfatal myocardial infarction or fatal CHD, occurred. Healthy lifestyle score was inversely associated with CHD risk in both the whole population (Ptrend <0.0001) and men already taking lipid-lowering or antihypertensive drugs for coronary risk factors (Ptrend <0.0001). The authors estimated that 62% of CHD cases in this population may have been avoided had all men been at low risk for all five lifestyle factors.

The authors conclude that many cases of CHD in middle-aged and older men—even in men already taking lipid-lowering or antihypertensive medication—may be avoided if individuals adhere to a healthy lifestyle.