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Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study
Study Questions:
What is the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of myocardial infarction (MI) in men?
Methods:
The population-based, prospective cohort of Swedish men was comprised of 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included five factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10-30 g/day), no smoking, being physically active (walking/bicycling ≥40 minutes/day and exercising ≥1 hour/week), and having no abdominal adiposity (waist circumference <95 cm).
Results:
During 11 years of follow-up, there were 1,361 incident cases of MI. Overall, men with a low-risk diet were more likely to have attained a higher level of education and to not smoke, and were less likely to live alone, compared with men with lower scores of recommended foods. The low-risk dietary choice, together with moderate alcohol consumption, was associated with a relative risk of 0.65 (95% confidence interval [CI], 0.48-0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI, 0.04-0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI, 34%-93%) of the MI events on the basis of the study population. Additionally, among >20,000 Swedish men in this study, the combination of a healthier diet, moderate alcohol use, nonsmoking, and regular exercise was associated with a 64% lower risk of MI even when excluding all subjects with existing hypertension, high cholesterol, or diabetes.
Conclusions:
The authors concluded that almost four of five MIs in men may be preventable with a combined low-risk behavior.
Perspective:
The impact of the healthy lifestyle in high-risk men in this study exceeds the value attributable to both statins and antihypertensive treatments, and provides support for a prevention effort that incorporates the components of cardiac rehabilitation in the care of high-risk men. The study also adds to the potential dramatic reduction in cardiovascular events and deaths and the cost savings that would occur with a primordial prevention population approach to lifestyle beginning in childhood and continuing into adulthood. That only 1% of the Swedish population of men is very low risk, tells us how important it is to start early and involve local, state, and federal government in programs that promote a healthy lifestyle. Some funds have become available, but much more is needed in the lower socioeconomic groups in whom the incidence and prevalence of diabetes and cardiovascular disease is on the uptrend.
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