Four Healthy Lifestyle Behaviors Lower Risk of Death, Slow CAC Progression

June 04, 2013

BALTIMORE, MD — Adopting a healthy lifestyle, one that includes not smoking, eating right, daily physical activity, and a healthy weight, is associated with a low incidence of calcium in the coronary arteries, as well as a slower progression of coronary artery calcium as measured over a three-year period, according to the results of a new study[1].

Most important, scoring higher on the lifestyle score was associated with a lower risk of all-cause mortality, report investigators in their paper, published online June 4, 2013 in the American Journal of Epidemiology.

"Everyone knows that healthy lifestyle habits are major factors that protect you from heart disease," lead investigator Dr Haitham Ahmed (Johns Hopkins Hospital, Baltimore, MD) told heartwire . "What we don't know is which habits are most important and how exactly these habits prevent disease progression along the causal biological pathway over years and years. This is the first study to look at biological progression every step of the way in a single longitudinal fashion."

The study included 6229 US adults aged 44 to 84 years old participating in the Multi-Ethnic Study of Atherosclerosis (MESA). All patients were given a lifestyle score, ranging from 0 to 4, based on whether or not they followed a Mediterranean-style diet, their exercise habits (achieving 150 minutes of moderate-intensity physical activity per week), body-mass index (BMI), and smoking status. One point was awarded for each healthy lifestyle behavior. The patients also underwent coronary artery calcium screening at baseline and a follow-up scan was performed 3.1 years later.

Overall, just 2% of the MESA participants met all four healthy-lifestyle criteria. The median annual progression in coronary artery calcium for individuals with a score 0, 1, 2, 3, and 4 was 25 Agatston points/year, 20 points/year, 18 points/year, 18 points/year, and 14 points/year, respectively. After adjustment for baseline variables, as well as the years between scans, those with scores of 1, 2, 3, and 4 had adjusted annual progressions of coronary calcium that were slower by 3.5 points/year, 4.2 points/year, 6.8 points/year, and 11.1 points/year, respectively, when compared with those with a score of 0.

Lower Risk of Death

Clinically, a healthier lifestyle also translated into a significant reduction in all-cause mortality and a trend toward lower coronary heart disease risk over a seven-year follow-up period. Individuals who adopted all four healthy behaviors had an approximate 80% lower risk of death than those with no healthy behaviors.

"The benefits were cumulative, meaning the more healthy behaviors, the better," commented Ahmed. "So if you maintained a normal weight and ate healthy but weren’t exercising, this shows you can still have even more benefit from adding exercise to your life."

Of the behaviors investigated, however, smoking was the most devastating. "In fact, if you exercised, ate healthily, and maintained normal weight, but smoked, you still were worse off than people who did nothing else right but stayed away from cigarettes. This really highlighted how important it is to stay away from smoking. It is probably singlehandedly the best thing you can do for your cardiovascular and overall health."

Most important, Ahmed noted that the lifestyle variables measured in the MESA cohort are those that can be altered at very little cost to the individual or to the healthcare system. "You can't pick your family history or change your age, but you can start exercising today, and you can start changing your diet today," Ahmed told heartwire . "All these interventions are things that cost us very little to nothing and are 100% in our hands. Our patients have the ability to control their own wellness and health."

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