Four lifestyle changes linked to reduced mortality

A large multicenter study funded by the National Heart, Lung and Blood Institute provides new evidence that four lifestyle changes recommended by the American Heart Association can reduce risk of coronary heart disease (CHD) and mortality.

Published in the Journal of Epidemiology, the Multi-Ethnic Study of Atherosclerosis (MESA) was carried out by Johns Hopkins investigators. They followed more than 6000 African American, Hispanic, and Chinese men and women aged 44 to 84 from 2000 to 2010. Using diet, exercise, body mass index, and smoking status, a lifestyle score was computed for each individual, ranging from 0 to 4.

The researchers found that making just 4 changes-getting regular exercise, eating a Mediterranean-style diet, maintaining a normal weight, and not smoking-- provided protection from CHD, reduced the possibility of death from other heart-related causes, and prevented early buildup of calcium deposits in arteries in the heart by roughly 80% over the period studied.

None of the participants had been diagnosed with any form of CHD before entering the study. At baseline, each participant had a coronary calcium screening, done through a computed tomography scan; rescanning was done an average of 3.1 years later.

At health scores of 1, 2, 3, and 4 were 3.5 (95% confidence interval (CI): 0.0, 7.0), 4.2 (95% CI: 0.6, 7.9), 6.8 (95% CI: 2.0, 11.5), and 11.1 (95 CI: 2.2, 20.1) points per year lower, respectively than the reference group (P = 0.003). Unadjusted hazard ratios for death by lifestyle score were 0.79 (95% CI: 0.61, 1.03), 0.49 (95% CI: 0.46, 0.81), 0.49 (95% CI: 0.32, 0.75) and 0.19 (95% CI: 0.05, 0.75) for lifestyle scores from 1 to 4, respectively (P<0.001) 

Of the 4 lifestyle choices, smoking avoidance had the biggest impact. Even when maintaining 2 or more other healthy behaviors, however, smokers had lower survival rates over the study period than nonsmokers.