Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men

TLDR

Healthy lifestyle choices—prudent diet, regular exercise, weight control, and non‑smoking—can markedly lower CHD risk by improving lipids, blood pressure, and other risk factors. The study aimed to quantify the preventable burden of CHD in middle‑aged and older US men, including those on hypertension or hypercholesterolemia medication, by evaluating adherence to modifiable lifestyle factors. Researchers followed 42,847 men aged 40–75, updating lifestyle factors through questionnaires and defining low risk as non‑smoking, BMI < 25, ≥30 min/day moderate‑to‑vigorous activity, moderate alcohol, and top 40% diet score. Across 16 years, 2,183 CHD events were recorded; men with low risk for all five lifestyle factors had an 87% lower risk (RR 0.13), and 62% of events—57% among those on hypertension or hypercholesterolemia medication—could have been prevented, while adopting ≥2 additional low‑risk factors lowered risk by 27%.

Abstract

Healthy lifestyle choices such as eating a prudent diet, exercising regularly, managing weight, and not smoking may substantially reduce coronary heart disease (CHD) risk by improving lipids, blood pressure, and other risk factors. The burden of CHD that could be avoided through adherence to these modifiable lifestyle factors has not been assessed among middle-aged and older US men, specifically men taking medications for hypertension or hypercholesterolemia.We prospectively monitored 42 847 men in the Health Professionals Follow-up Study, 40 to 75 years of age and free of disease in 1986. Lifestyle factors were updated through self-reported questionnaires. Low risk was defined as (1) absence of smoking, (2) body mass index <25 kg/m2, (3) moderate-to-vigorous activity > or = 30 min/d, (4) moderate alcohol consumption (5 to 30 g/d), and (5) the top 40% of the distribution for a healthy diet score. Over 16 years, we documented 2183 incident cases of CHD (nonfatal myocardial infarction and fatal CHD). In multivariate-adjusted Cox proportional hazards models, men who were at low risk for 5 lifestyle factors had a lower risk of CHD (relative risk: 0.13; 95% confidence interval [CI]: 0.09, 0.19) compared with men who were at low risk for no lifestyle factors. Sixty-two percent (95% CI: 49%, 74%) of coronary events in this cohort may have been prevented with better adherence to these 5 healthy lifestyle practices. Among men taking medication for hypertension or hypercholesterolemia, 57% (95% CI: 32%, 79%) of all coronary events may have been prevented with a low-risk lifestyle. Compared with men who did not make lifestyle changes during follow-up, those who adopted > or = 2 additional low-risk lifestyle factors had a 27% (95% CI: 7%, 43%) lower risk of CHD.A majority of CHD events among US men may be preventable through adherence to healthy lifestyle practices, even among those taking medications for hypertension or hypercholesterolemia.