In patients with self-reported coronary heart disease (CHD) or stroke, the prevalence of healthy lifestyle behaviors including smoking status, level of exercise, and diet, is low across countries with varying income levels, and even lower levels in poorer countries, according to a study published on April 16 in the Journal of the American Medical Association.

Additional Resources Full Study Journal Scan ACC International Center ACC Efforts Lead to Passage of Landmark Global NCD Targets by WHO CardioSmart for Your Patients: Smoking Cessation CardioSmart for Your Patients: Staying Motivated to Move CardioSmart for Your Patients: Eating a Heart-Healthy Diet

The Prospective Urban Rural Epidemiology (PURE) study was a large, prospective cohort study using an epidemiological survey of 153,996 adults from 628 urban and rural communities with varying income levels. Results showed among 7,519 individuals with CHD or stroke, 18.5 percent continued to smoke; only 35.1 percent undertook high levels of work- or leisure- related physical activity; and only 39 percent had healthy diets.

In addition, the prevalence of smoking cessation was highest in the high-income countries (74.9 percent; 95 percent CI, 7.1 percent – 78.6 percent) and lowest in the low-income countries (38.1 percent; 95 CI, 33.1 percent – 43.2 percent). Further, low-income countries had the lowest prevalence of healthy diets (25.8 percent) compared with lower-middle-income countries (43.2 percent), upper-middle-income countries (45.1 percent), and high-income countries (43.4 percent). Although there were differences in the level of exercise by country, the authors note that they did not reach statistical significance.

The authors note that "a large gap exists globally between actual and ideal participation in the three key lifestyle behaviors." They add that "substantial proportions," of 14.3 percent did not take part in any of the three healthy lifestyle behaviors.

The low prevalence of healthy lifestyle behaviors was observed worldwide, but more so in poorer countries, the authors conclude. Based on these results, "development of simple, effective, and low-cost strategies for secondary prevention [would be applicable] worldwide," they add.

Keywords: Stroke, Exercise, Coronary Disease, Health Behavior, Prevalence, Rural Population, Secondary Prevention, Leisure Activities, Diet, United States, Smoking Cessation

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