Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle
Open accessAbstract
BACKGROUND: Many lifestyle-related risk factors for coronary heart disease have been identified, but little is known about their effect on the risk of disease when they are considered together. METHODS: We followed 84,129 women participating in the Nurses' Health Study who were free of diagnosed cardiovascular disease, cancer, and diabetes at base line in 1980. Information on diet and lifestyle was updated periodically. During 14 years of follow-up, we documented 1128 major coronary events (296 deaths from coronary heart disease and 832 nonfatal infarctions). We defined subjects at low risk as those who were not currently smoking, had a body-mass index (the weight in kilograms divided by the square of the height in meters) under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fiber, marine n-3 fatty acids, and folate, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load, which reflects the extent to which diet raises blood glucose levels. RESULTS: Many of the factors were correlated, but each independently and significantly predicted risk, even after further adjustment for age, family history, presence or absence of diagnosed hypertension or diagnosed high cholesterol level, and menopausal status. Women in the low-risk category (who made up 3 percent of the population) had a relative risk of coronary events of 0.17 (95 percent confidence interval, 0.07 to 0.41) as compared with all the other women. Eighty-two percent of coronary events in the study cohort (95 percent confidence interval, 58 to 93 percent) could be attributed to lack of adherence to this low-risk pattern. CONCLUSION: Among women, adherence to lifestyle guidelines involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease.
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People who adhere to a healthy lifestyle have markedly reduced rates of incident cardiovascular events.
“Much evidence has also shown that persons who adhere to a healthy lifestyle have markedly reduced rates of incident cardiovascular events.25–30”
From Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease (2016) · cites this paper as [25]
Most of these disease burdens are preventable and occur at unnecessarily younger ages, largely because of suboptimal lifestyle factors including poor diet, excess calories, inactivity, and smoking.
“Most of these burdens are preventable and are occurring at unnecessarily younger ages, largely owing to suboptimal lifestyle, which includes poor diet quality, excess caloric intake, physical inactivity, and smoking.2–5”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [4]
Evaluated systematically, >70% of total cardiovascular events, 80% of CHD events, and 90% of new cases of diabetes mellitus appear to be attributable to just a handful of basic lifestyle factors.
“Evaluated systematically, Ͼ70% of total cardiovascular events, 80% of CHD events, and 90% of new cases of diabetes mellitus appear to be attributable to just a handful of basic lifestyle factors.60,61”
From Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease (2008) · cites this paper as [61]
A healthy lifestyle has been associated with lower risk of incident coronary events among middle-aged women and lower risk of CHD mortality in a population of elderly men and women.
“A healthy lifestyle has been associated with lower risk of incident coronary events among middle-aged women 13 and lower risk of CHD mortality in a population of elderly men and women.14”
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- Authors
- Stampfer, M. J., Hu, F. B., Manson, J. E., Rimm, E. B., & Willett, W. C.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-07-06
- Volume
- 343
- Issue
- 1
- Pages
- 16-22
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2332987513
- Cited by
- 1,794
- References
- 40
- Citations by year
- 2026: 18 · 2025: 28 · 2024: 31 · 2023: 82 · 2022: 40 · 2021: 44 · 2020: 64 · 2019: 53 · 2018: 73 · 2017: 69 · 2016: 89 · 2015: 70 · 2014: 84 · 2013: 85 · 2012: 95
- FWCI
- 56.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL60712, R01HL060712, HL24074, HL34594, R01HL034594)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- coronary artery disease, primary prevention, women, lifestyle risk factors, diet, physical activity, smoking, body mass index, cereal fiber, omega-3 fatty acids, folic acid, polyunsaturated to saturated fat ratio, trans fatty acids, glycemic load, coronary events, Nurses' Health Study
- MeSH terms
- Adult, Coronary Disease, Diet, Female, Humans, Life Style, Middle Aged, Risk, Smoking, Cohort Studies, Health Behavior, Exercise
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