Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women | Journal Scan

Study Questions:

What is the proportion of coronary heart disease (CHD) cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle?


The Nurses’ Health Study II was used for the present analysis. Women ages 27-44 years of age followed from 1991 to 2011 were included as long as they had no clinically apparent CVD at baseline. Lifestyle factors were assessed via questionnaire periodically through the course of the study. Lifestyle factors examined included smoking status, body mass index (BMI), alcohol intake, physical activity (healthy defined as >2.5 hours per week), television (healthy defined as <7 hours per week), and diet in the top 40% of the Alternative Healthy Eating Index. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, the population-attributable risk percent was calculated.


During 20 years of follow-up, 456 women had documented incident CHD and 31,691 reported a physician diagnosis of one or more clinical CVD risk factors (n = 2,749 with diabetes, n = 16,978 with hypertension, and n = 23,971 with hypercholesterolemia). The mean (standard deviation [SD]) age of the population at baseline was 37.1 (4.5) years, while the mean (SD) age at diagnosis of CHD was 50.3 (5.9) years and the mean (SD) age at diagnosis with a clinical CVD risk factor was 46.8 (6.2) years. In multivariable-adjusted models, nonsmoking, healthy BMI, exercise, and healthy diet were independently and significantly associated with lower CHD risk. Compared to women with no healthy lifestyle factors, the hazard ratio (HR) for CHD for women with six lifestyle factors was 0.08 (95% confidence interval [CI], 0.03-0.22). Approximately 73% (95% CI, 39%-89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% CI, 43%-49%) of clinical CVD risk factor cases were attributable to poor lifestyle.


The authors concluded that primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD.


These data add further evidence that early and consistent healthy lifestyle dramatically reduces risk for future heart disease. Finding public health interventions which assist people in sustained healthy lifestyles remains a challenge.

Clinical Topics: Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Diet, Hypertension, Smoking

Keywords: Alcohols, Body Mass Index, Coronary Disease, Cost of Illness, Diabetes Mellitus, Diet, Hypercholesterolemia, Hypertension, Life Style, Motor Activity, Questionnaires, Risk Factors, Smoking, Television

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