Primary Prevention of MI: Swedish Study Demonstrates Significant Impact of Lifestyle Choices

Posted by The Evidence Blog on October 9, 2014

A prospective, long-term study demonstrated that a combination of modifiable lifestyle factors was associated with a lower risk of myocardial infarction (MI) among a cohort of Swedish men.

Healthy lifestyle choices are commonly believed to reduce the risk of MI. However, few large, population-based, prospective studies have examined the long-term impact of healthy diet, healthy behaviors, and exercise on the incidence of MI. Researchers in Sweden followed a prospective cohort of Swedish men who completed a diet and lifestyle questionnaire in 1997. The cohort was comprised of 45- to 79-year-old healthy men with no history of cancer, cardiovascular disease, diabetes, hypertension, or elevated cholesterol levels. The questionnaire assessed 5 key modifiable factors: diet, alcohol consumption, smoking status, level of physical activity, and abdominal adiposity.

“Low-risk” factors were defined as a healthy diet based on a score in the highest quintile (23 to 25 points) of the Recommended Food Score, which values fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains, and fish as “healthy”; low-risk alcohol consumption (10 to 30 grams daily), nonsmoking status, physical activity (walking or bicycling ≥ 40 minutes per day and more vigorous exercise ≥ 1 hour per week); and low abdominal adiposity (waist circumference

A total of 20,721 men were followed from January 1998 through 2009. The total incidence of MI over the course of 11 years was 1361 (6.6%). A combination of all 5 low-risk factors was associated with an 86% lower risk of MI compared with no low-risk factors. The population-attributable MI risk reduction estimate was 79% for the 1% of the study population that adhered to all 5 low-risk factors compared with the rest of the study population. This translated to approximately 4 out of 5 cases of MI possibly avoided by practicing a healthy diet plus the other 4 low-risk factors.

Not smoking was demonstrated to be the most beneficial in terms of reducing the relative risk of MI as an independent factor (36% reduction in risk), followed by healthy diet (18% reduction in risk), and lack of excess abdominal fat (12% reduction in risk). The dietary evidence supports that the benefit achieved was attributed to eating healthier foods rather than curtailing intake of unhealthy foods such as red meat, solid fats, white bread, and sweets, among others.

The study suggests that primary prevention via adherence to a combination of low-risk lifestyle factors produces substantial benefits for cardiovascular health.

  1. Åkesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study. J Am Coll Cardiol. 2014;64(13):1299-1306. Available at: Accessed October 8, 2014.

Topics: Hayes Blog

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