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Heart disease risk and your
lifestyle A recently-published analysis from the Nurses' Health Study found that subjects in the low-risk-lifestyle group had only 17 percent of the risk to develop coronary artery disease as the other women in the study. Every now and then, a scientific report comes
along that emphasizes the association between lifestyle and health. Subjects
in the low-risk group were nonsmokers who ate a healthful diet and exercised
at least 30 minutes per day.
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Body mass index (BMI) is a pretty good estimate of obesity,
on average. While some very muscular people will be counted as obese when
they are actually very lean, the overall results will not be affected by
this small error. The standard cutoff for obesity is a BMI of 25, which was the number used in this study to define the low-risk lifestyle group. The researchers mention that in previous analyses, however, they calculated that even a BMI of 23 or 24 is riskier than a BMI of 21 or less. Research suggests that higher BMIs are associated with insulin resistance, which is associated with a riskier blood lipid profile. Physical activity The more minutes per day spent performing moderate to vigorous physical activity, the less the risk of heart disease. While the low-risk group was defined as exercising at a moderate to vigorous intensity for at least 30 minutes a day, the researchers acknowledged that more activity was better. How did the researchers define physical activity? They counted activities that were approximately 3 METs or higher, which excludes normal walking, but includes walking at a pace equal to or greater than 3 miles per hour. The questionnaire asked about activities that were "strenuous enough to build up a sweat." Dietary habits The dietary habits included in the low-risk-profile group were chosen from previous research studies supporting their connection to cardiovascular risk reduction. Each subject's diet score was based on the following ingredients: |
Fat intake. Subjects scored best if they had low
intakes of trans fats and saturated fats, and higher intakes of unsaturated
fats.
Fiber. Subjects who ate higher amounts of cereal fiber scored better. Cereal
fiber is found in whole grains, brans and their products. Low-risk nurses
consumed more than 4.2 grams of fiber per day.
Marine n-3 fatty acids. These fats come from fish and fish oils. The
low-risk group consumed more than 0.1 percent of their daily calories in the
form of these fats. So for a 2,000-Calorie diet, that is 2 Calories, or 18
grams, of marine n-3 fatty acids per day, on average. In real life, this
translates into eating fish regularly.
Glycemic load. Glycemic load reflects both the glycemic index of foods (how
long it takes the carbohydrate in the food to appear as glucose in the
blood) and the volume of carbohydrate in the food. Higher glycemic load has
been associated with increased heart disease risk, especially in overweight
people. While no firm limit can be set for glycemic load at this point, the
researchers emphasize the importance of consuming heart-healthy fats and
protein along with nutritious carbohydrate foods, such as whole grains,
legumes, fruits and vegetables, while limiting sugars and refined grains.
Folate. Higher folate intakes gave women more points on their diet
classification. Low-risk women ate on the average more than 525 micrograms
of folate per day, through supplements and foods combined. (Current
recommended intake for folate is 400 micrograms per day for adult women and
men.)
Alcohol intake
Women were considered low-risk if they consumed on average at least one-half
of an alcoholic drink per day. Since alcohol intake is associated with an
increased risk for breast cancer, many women avoid alcohol, but this study
did not examine cancer risk. Small to moderate amounts of alcohol have been
found to be protective against heart disease in both men and women.
The importance of lifestyle
Our healthcare system puts most of its heart disease money and energy into
medical and surgical management: drugs to lower blood pressure and
cholesterol, surgery to fix clogged arteries, etc. Research from the Nurses'
Health Study, however, underscores the dramatic potential of lifestyle
changes for the prevention of coronary artery disease.
REFERENCE
1. Stampfer, M.J., F.B. Hu, J.E. Manson, E.B. Rimm and W.C. Willett. Primary
prevention of coronary heart disease in women through diet and lifestyle.
The New England Journal of Medicine 343: 16-22, Jul. 6, 2000.
Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith
College, Northampton, Mass.
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Instead of worrying about a food's glycemic index, keep an eye on portion sizes and consume carbohydrates with foods that are high in fiber and protein, and with moderate amounts of heart-healthy fats.