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

doi:10.1016/j.jacc.2014.10.024

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Referred to by

Donna K. Arnett
Healthy Habits, Healthy Women
Journal of the American College of Cardiology, Volume 65, Issue 1, 6–13 January 2015, Pages 52-54
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Abstract

Background

Overall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown.

Objectives

The aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle.

Methods

A prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses’ Health Study II who were followed from 1991 to 2011. Lifestyle factors were updated repeatedly by questionnaire. A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index–2010, and 0.1 to 14.9 g/day of alcohol. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent.

Results

During 20 years of follow-up, we documented 456 incident CHD cases. In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22). Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle.

Conclusions

Primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD.

Key Words

coronary disease;
diabetes;
epidemiology;
hypercholesterolemia;
hypertension;
risk factors

Abbreviations and Acronyms

AHEI-2010, Alternative Healthy Eating Index-2010;
BMI, body mass index;
CHD, coronary heart disease;
CI, confidence interval;
CVD, cardiovascular disease;
HR, hazard ratio;
PAR%, population-attributable risk percent

This study was supported by grants UM1 CA176726 and R01 CA050385 from the National Institutes of Health. Dr. Chomistek was supported by an institutional training grant (DK007703) from the National Institute of Diabetes and Digestive and Kidney Diseases. The sponsors were not involved in the design and conduct of the study; collection, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

: Reprint requests and correspondence: Dr. Andrea K. Chomistek, Indiana University Bloomington, School of Public Health, Department of Epidemiology and Biostatistics, 1025 East 7th Street, Room C101, Bloomington, Indiana 47405.