Healthy Diet and Lifestyle Cut MI Risk, Heart Failure

A new Swedish study looking at the benefit of a combination of several healthy lifestyle behaviors has found that most myocardial infarctions (MIs) in women could be prevented by consuming a healthy diet, being physically active, not smoking, and maintaining a healthy weight [1].

Dr Agneta Akesson (Karolinska Institute, Stockholm, Sweden) and colleagues report their findings in the October 22, 2007 issue of the Archives of Internal Medicine. They say there is little prior information on the benefit achieved with a combination of several healthy lifestyle behaviors. The results indicate that the combined benefit of diet, lifestyle, and healthy body weight "may prevent more than three of four cases of MI," they note.

"Our study shows the great effect you get from each of these and by combining them," Akesson told heartwire. "It's quite a simple health message, and you can do them by yourself."
In healthiest women, 92% decreased risk of MI

The Swedish researchers say coronary heart disease (CHD) risk-factor characterization and prevention in women need improvement, and despite the proven benefits of pharmacologic therapies, "diet and lifestyle largely influence morbidity and mortality in CHD."

One of the novel things the Swedish group did was to assess behavioral dietary patterns among the 24,444 postmenopausal women they studied, who were participating in the population-based prospective Swedish Mammography Cohort and who were free of diagnosed cancer, cardiovascular disease, and diabetes mellitus at baseline (September 15, 1997).

They identified four major dietary patterns: healthy (vegetables, fruits, and legumes); Western/Swedish (red meat, poultry, rice, pasta, eggs, fried potatoes); alcohol; and sweets (sweet baked goods, candy, chocolate). Those who consumed moderate amounts of alcohol (5 g or more a day; equivalent to a glass of wine every other day) were categorized as low risk. No upper limit for alcohol consumption was defined, because few women consumed high amounts of alcohol (less than 0.3% reported drinking more than 45 g/day). Those in the lowest-risk quintile for diet had an almost fourfold higher weekly consumption of vegetables and fruits, a threefold higher consumption of legumes, and a 70% higher consumption of fish compared with the highest-risk quintile.

During a mean of 6.2 years of follow-up, there were 308 incident cases of primary MI, of which 51 were fatal.

The researchers defined a low-risk dietary behavior based on high scores for the healthy dietary pattern (low-risk quintiles 3-5) and, when combined with moderate alcohol intake, this group had a significant 57% reduction in primary MI.

The researchers also defined three low-risk lifestyle factors: nonsmoking, waist/hip ratios less than the 75th percentile (<0.85), and being physically active.

The 5% of the study population who ate healthily, drank alcohol in moderation, and maintained these three low-risk lifestyle behaviors had a 92% decreased risk of MI compared with women without any low-risk diet and lifestyle factors.

Healthy Diet And Lifestyle Behaviors Associated With Decreased Risk Of Heart Attack In Women

Women who eat a healthy diet, drink moderate amounts of alcohol, are physically active, maintain a healthy weight and do not smoke have a significantly reduced risk of heart attack, according to a new report in the Archives of Internal Medicine.
"Coronary heart disease is the most important cause of death and disability in women," the authors write as background information in the article. "Despite a lower incidence in women, coronary heart disease--related mortality and the percentage of sudden deaths from coronary heart disease without previous symptoms is higher and the trend of decline in incidence is slower than in men."

Agneta Akesson, Ph.D., M.P.H., of the Karolinska Institutet, Stockholm, and colleagues identified dietary patterns in 24,444 postmenopausal women by analyzing food frequency questionnaires, on which the women supplied information about how often they ate 96 common foods.

"We derived four major dietary patterns: 'healthy' (vegetables, fruits and legumes), 'Western/Swedish' (red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes and fish), 'alcohol' (wine, liquor, beer and some snacks) and 'sweets' (sweet baked goods, candy, chocolate, jam and ice cream)," the authors write. Participants also answered questions about education, family history, health status, use of medications, body measurements and physical activity. When they enrolled in the study in 1997, none of the women had heart disease, diabetes or cancer.

Over an average of 6.2 years of follow-up, 308 women had a new myocardial infarction (heart attack); 51 of these cases were fatal. Two diet types--"healthy" and "alcohol"--were associated with a reduced risk for heart attack.

"The low-risk diet (high scores for the healthy dietary pattern) characterized by a high intake of vegetables, fruit, whole grains, fish and legumes, in combination with moderate alcohol consumption (5 grams of alcohol per day or less), along with the three low-risk lifestyle behaviors [not smoking, having a waist-hip ratio of less than the 75th percentile and being physically active], was associated with 92 percent decreased risk compared with findings in women without any low-risk diet and lifestyle factors," the authors write. "This combination of healthy behaviors, present in 5 percent, may prevent 77 percent of myocardial infarctions in the study population."

Several components of fruits, vegetables and whole grains--including fiber, antioxidant vitamins and minerals--have been associated with a reduced risk for coronary heart disease, the researchers note. In addition, previous studies have found beneficial effects of small amounts of alcohol in preventing the buildup of plaque in the arteries, which could help prevent heart attacks.

"Our study findings indicate that healthy dietary behaviors are present in the population," the authors conclude. "These dietary behaviors together with a healthy lifestyle and body weight may prevent most myocardial infarction events."

Reference: Arch Intern Med. 2007;167(19):2122-2127.

This study was supported by research grants from the Center for Health Care Sciences, Karolinska Institutet; the Swedish Research Council/Medicine and Longitudinal Studies; and the Swedish Council for Working Life and Social Research.