Primordial prevention through the maintenance of a healthier lifestyle among young women may substantially lower the burden of cardiovascular disease, according to a study published Jan. 5 in the Journal of the American College of Cardiology.

In recent decades the overall mortality rates from coronary heart disease (CHD) in the U.S. have significantly declined. However, this rate has plateaued among younger women. Believing that the proportion of CHD cases and clinical cardiovascular disease risk factors among young women are attributable to poor adherence to a healthy lifestyle, Andrea Chomistek, ScD, Department of Epidemiology and Biostatistics, School of Public Health, Indian University, and her colleagues conducted a prospective analysis among 88,940 women, aged 27-44 years, following them from 1991-2011. Defining a healthy lifestyle as not smoking, having a normal body mass index (BMI), engaging in ≥2.5 hours/week of physical activity, ≤7 hours/week of television, a diet in the top 40 percent of the Alternative Healthy Eating Index-2010, and 0.1-14.9 g/day of alcohol, Chomistek et al. were updated repeatedly by questionnaire.

Across 20 years of follow-up, Chomistek and her fellow investigators documented 456 incident CHD cases. In multivariable-adjusted models, non-smoking, having a healthy BMI, exercising, and diet were independently and substantially associated with a lower CHD risk. Compared to women who had no healthy lifestyle factors, the hazard ratio for CHD for women with six lifestyle factors was 0.08 (95 percent CI: 0.03 to 0.22). Approximately 73 percent (95 percent CI: 39 percent to 89 percent) of CHD cases came as a result of poor adherence to a healthy lifestyle, while 46 percent (95 percent CI: 43 percent to 49 percent) of clinical cardiovascular disease risk factor cases were attributable to poor lifestyle.

The authors conclude that “promoting adherence to a healthy lifestyle has the potential to not only substantially reduce the burden of CHD and cardiovascular disease-related conditions, but could be a simple, but important, strategy to lower overall morbidity and premature death in young and middle-aged women. Primordial prevention provides enormous potential for future reductions in CHD rates in young women.”

“To competent clinicians on the front lines of primary and primordial prevention, these results will not be terribly surprising,” writes Donna Arnett, MSPH, PhD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, in a coinciding editorial. “Exercise and activity, diet and weight, tobacco use, and alcohol consumption have long been important behavioral targets in individual and population-level cardiovascular disease reduction campaigns – we know they are important... All that remains is the task of successfully convincing young adults not to smoke, to exercise more, and to eat and drink prudently.”

Arnett adds, “If there's any hope in successfully convincing young women (and everyone else) not to smoke, to exercise more, and to eat and drink prudently, it lies in creating a world where doing those things is the default option. We should thank Chomistek and colleagues for providing another compelling analysis to spur this vision of the future.”

Keywords: Alcohol Drinking, Body Mass Index, Coronary Disease, Cost of Illness, Diet, Life Style, Mortality, Premature, Motor Activity, Surveys and Questionnaires, Risk Factors, Smoking, Television, Tobacco Use

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