Very Few People With Established CVD Adhere to Healthy Habits: PURE

Shelley Wood

April 18, 2013

HAMILTON, ON — Only a fraction of people who have established heart disease or a past stroke are adhering to the most basic lifestyle recommendations known to reduce their risk of a future event[1]. Those are the latest findings from the sweeping Prospective Urban Rural Epidemiology (PURE) study, a global snapshot of cardiovascular disease risk factors and health status encompassing both rich and poor nations and urban and rural communities.

Previous analyses from PURE have highlighted the underuse of proven medications for the secondary prevention of CVD (particularly in underdeveloped countries), published in the Lancet[2], as well as the unhealthy habits of all PURE participants, rich or poor, regardless of whether they have heart disease or not. PURE was conducted in 17 countries, across more than 600 communities, and enrolled 153 996 adults.

"This is a parallel piece to the article on the use of secondary prevention medicine in the Lancet," lead author Dr Koon Teo (McMaster University, Hamilton, ON) told heartwire . "The importance of this [latest] piece is that even in people who already had disease, the prevalence of healthy lifestyles was still low."

In their latest paper, published in the April 17, 2013 issue of the Journal of the American Medical Association, Teo and colleagues, with senior author Dr Salim Yusuf (McMaster University), zero in on the 7519 PURE study participants who had self-reported coronary heart disease or previous stroke. As Teo and colleagues note, 18.5% continued to smoke following their index diagnosis, only 35% took up high levels of work- or leisure-related physical activity, and just 39% reported following a healthy diet.

In all, 14% reported not engaging in any of the three healthy lifestyle behaviors defined by the study, while just 4% tried to adopt all three.

Just over half of subjects with previous heart disease or stroke quit smoking, with the high-income countries being more likely to quit than subjects in lower-income countries. Increasing levels of physical activity were also more common in higher-income countries, although this trend was not statistically significant. The proportion of people eating healthy diets was higher in the higher-income countries than in the lower-income countries, but in no countries was adherence to the healthy habits anywhere close to optimal.

"Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries," Teo et al conclude.

"This study shows that a large gap exists globally between actual and ideal participation in the three key lifestyle behaviors of avoidance of (or quitting) smoking, undertaking regular physical activity, and eating a healthy diet after a CHD or stroke event," they write. "Nearly one-fifth of individuals continued to smoke, only about one-third undertook high levels of physical activity, and only two-fifths were eating a healthy diet."

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