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Cited by 543Health Promotion and Cardiovascular PreventionGlobal Cancer Incidence and ScreeningCardiovascular Health and Risk Factors

Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association

Open access
Eyre, Harmon, Kahn, Richard, Robertson, Rose Marie, the ACS/ADA/AHA Collaborative Writing Committee, ACS/ADA/AHA Collaborative Writing Committee Members, Clark, Nathaniel G., Doyle, Colleen, Hong, Yuling +5 more·2004·Circulation
DOI 10.1161/01.cir.0000133321.00456.00
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Abstract

Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about $700 billion in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity—the major risk factors for these diseases—and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the ACS, ADA, and AHA review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.

AI snapshot

Written from the paper’s full text.

TL;DR

This ACS/ADA/AHA scientific statement argues that cardiovascular disease, cancer, and diabetes share major modifiable risk factors and that coordinated primary prevention and early detection could substantially reduce deaths and economic costs. It reviews disease burden, risk factors, screening, and calls for collaboration, periodic preventive visits, and policy/advocacy.

Key findings

  • Cardiovascular disease, cancer, and diabetes accounted for 65% of all deaths in 2000; in 2001, CVD caused 931,108 deaths (38.5%), all cancers 553,768 (22.9%), and diabetes 71,372 (3.0%). Estimated 2003 costs were $351.8 billion for CVD, $189.5 billion for cancer, and $132.0 billion for diabetes.
  • Tobacco use is the single largest preventable cause of disease and premature death in the United States: approximately 440,000 Americans die each year from active smoking, and an additional 38,000 nonsmokers die from environmental tobacco smoke; tobacco-related economic losses were estimated at $157.7 billion annually from 1995 to 1999. About 30% of all cancer deaths are attributable to active smoking.
  • In 1999–2000, 64% of US adults were overweight or obese and 30.5% were obese; obesity costs were estimated at approximately $117 billion annually. An estimated 70% of type 2 diabetes risk is attributable to overweight and obesity, and each kilogram of weight gain over 10 years increases risk by 4.5%.
  • Cancers detectable by screening account for half of all new cancer cases; 5-year relative survival for these cancers is about 84%, and would increase to about 95% if all were diagnosed at a localized stage through regular screening. Mammography service screening has shown mortality reductions of approximately 50% in women who participate regularly.

Methods

  • Design: a joint scientific statement/consensus review by the ACS, ADA, and AHA Collaborative Writing Committee, not an original empirical study.
  • Data: synthesizes national statistics, epidemiological studies, randomized trials, and guidelines, including Healthy People 2010, USPSTF reviews, CDC data, NHANES, SEER, the Diabetes Prevention Program, and the Finnish Diabetes Prevention Study.
  • Analysis: narrative review and recommendations for prevention and early detection; no systematic review, meta-analysis, or new primary data analysis is described.

Limitations

  • The paper states that many unanswered questions remain about the science underlying recommendations for behaviors and interventions in chronic disease prevention and control. It also states there is incomplete evidence on how single nutrients, combinations of nutrients, overnutrition and energy imbalance, or body fat amount/distribution influence risk for specific cancers, and that it is not clear whether losing weight reduces cancer risk.
  • The paper states that none of the diabetes-prevention studies explicitly addressed the age at which screening should begin, the optimal frequency of screening, or other indications for screening.
  • Evident from the text: as a scientific statement/narrative review, it does not report a systematic search strategy, formal quality appraisal, or new empirical analysis; recommendations rely on existing evidence and expert consensus.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/01.cir.0000133321.00456.00

Cites

121 of 121 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Premisecitation

    The national investment in prevention was estimated at less than 3% of total annual healthcare expenditures.

    “the national investment in prevention was estimated at less than 3% of the total annual healthcare expenditures.”
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  • Interpretationreasoning

    Systematic application of known prevention and early detection interventions could substantially reduce the human and economic burden of cardiovascular disease, cancer, and diabetes.

    “A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity-the major risk factors for these diseases-and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases.”
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    At present, preventive health receives only sporadic attention, in the context of office visits for acute and chronic medical problems.

    “At present, preventive health receives only sporadic attention, in the context of office visits for acute and chronic medical problems.”
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  • Interpretationnone given

    The great majority of deaths from tobacco could be prevented by reducing the initiation of tobacco use by children and adolescents and increasing the cessation of tobacco use among adults.

    “The great majority of deaths from tobacco could be prevented by reducing the initiation of tobacco use by children and adolescents and increasing the cessation of tobacco use among adults.”
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  • Premisecitation

    Tobacco smoking is causally related to at least 16 types of cancer.

    “Tobacco smoking is causally related to at least 16 types of cancer”
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  • Classified as probably not a substantial claim. 20

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    Premisenone given

    Cardiovascular disease, cancer, and diabetes share common risk factors and can be prevented or treated more effectively if diagnosed early.

    “Cancer, cardiovascular disease, and diabetes share common risk factors, and all of these diseases can also be prevented or treated more effectively if they are diagnosed early.”
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    Interpretationreasoning

    Current disease-control efforts for cardiovascular disease, cancer, and diabetes are underfunded and fragmented.

    “Despite the incontrovertible evidence supporting the medical and economic benefits of prevention and early detection, current disease-control efforts are underfunded and fragmented.”
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    Interpretationnone given

    Despite the abundance of data, guidelines, and objectives, progress in the nation's health falls well short of its true potential, and some trends are worsening.

    “Despite the abundance of data, guidelines, and objectives, progress in the nation's health falls well short of its true potential, and some trends are worsening.”
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    Premisecitation

    Smoking, physical inactivity, and overweight/obesity confer significant risk for developing cardiovascular disease, diabetes, and cancer.

    “All of these factors confer significant risk for developing cardiovascular disease, diabetes, and cancer.”
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    Premisecitation

    The prevalence of overweight and obesity in adults had risen to 65% in 1999-2000.

    “it also noted that the prevalence of overweight and obesity in adults had risen to 65% in 1999 -2000.”
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    Interpretationnone given

    Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge.

    “Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge.”
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    Premisecitation

    Too many Americans still smoke cigarettes and are physically inactive.

    “The report emphasized that too many Americans still smoke cigarettes and are physically inactive”
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    Premisecitation

    Excess body weight is an independent risk factor for cardiovascular diseases and causes other risk factors, such as hypertension, dyslipidemia, and type 2 diabetes.

    “Excess body weight is an independent risk factor for cardiovascular diseases and causes other risk factors, such as hypertension, dyslipidemia, and type 2 diabetes.”
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    Interpretationcitation

    The trends among children will influence future adult rates, because individuals who become overweight as children or adolescents are more likely to be overweight or obese as adults.

    “The trends among children will influence future adult rates, because individuals who become overweight as children or adolescents are more likely to be overweight or obese as adults.”
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    Interpretationcitation

    Although it is not clear whether losing weight reduces the risk of cancer, there are physiological mechanisms that suggest weight loss may be beneficial because overweight or obese individuals who lose weight intentionally have reduced levels of circulating glucose, insulin, bioavailable estrogens, and androgens.

    “Although it is not clear whether losing weight reduces the risk of cancer, there are physiological mechanisms that suggest weight loss may be beneficial because overweight or obese individuals who lose weight intentionally have reduced levels of circulating glucose, insulin, bioavailable estrogens, and androgens.”
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    Premisecitation

    Approximately 30% of all deaths from cancer in the United States are attributable to active smoking.

    “Approximately 30% of all deaths from cancer in the United States are attributable to active smoking.”
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    Premisecitation

    A recent study of approximately 900,000 individuals suggests that obesity may account for 14% of cancers in men and 20% of cancers in women, and in this cohort, the heaviest men and women were 52% and 62%, respectively, more likely to die of cancer.

    “A recent study of approximately 900 000 individuals suggests that obesity may account for 14% of cancers in men and 20% of cancers in women, and in this cohort, the heaviest men and women were 52% and 62%, respectively, more likely to die of cancer.”
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    Premisecitation

    Approximately one third of breast and cervical cancers and nearly two thirds of colorectal cancers are diagnosed at an advanced stage.

    “Approximately one third of breast and cervical cancers and nearly two thirds of colorectal cancers are diagnosed at an advanced stage.”
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    Premisecitation

    Among cancers caused by smoking, the strongest association is with lung cancer, the most common type of fatal cancer among both men and women in the United States.

    “Among these, the strongest association is with lung cancer, the most common type of fatal cancer among both men and women in the United States.”
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    Premisecitation

    The evidence that micronutrients influence the risk of diabetes is limited, although some studies suggest that certain micronutrients may affect glucose and insulin metabolism.

    “The evidence that micronutrients influence the risk of diabetes is limited, although some studies suggest that certain micronutrients may affect glucose and insulin metabolism.101”
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    Interpretationcitation

    This level of overnutrition, in addition to physical inactivity (38% of adults report no leisure-time physical activity), has contributed to the alarming increase in the levels of obesity and overweight over the past decade.

    “This level of overnutrition, in addition to physical inactivity (38% of adults report no leisure-time physical activity), 88 has contributed to the alarming increase in the levels of obesity and overweight over the past decade.”
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    Interpretationnone given

    Physical activity reduces chronic disease risk, both directly, through its impact on hormones, and indirectly, through its impact on weight control.

    “Supporting evidence continues to accumulate that physical activity reduces chronic disease risk, both directly, through its impact on hormones, and indirectly, through its impact on weight control.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The consistency of the recommendation for 30 minutes of daily physical activity, along with similar recommendations for reducing cancer and cardiovascular risks, suggests the potential for simplified health education messages about physical activity and disease prevention.

    “The consistency of this recommendation, along with similar recommendations for reducing cancer and cardiovascular risks, suggests the potential for simplified health education messages about physical activity and disease prevention.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Doll and Peto estimated that 35% (10% to 70%) of cancer deaths in the United States were attributable to diet, with no specific reference to obesity or physical inactivity.

    “Doll and Peto 32 first estimated that 35% (10% to 70%) of cancer deaths in the United States were attributable to diet, with no specific reference to obesity or physical inactivity.”
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    Premisecitation

    McGinnis and Foege attributed 14% of all deaths occurring in the United States in 1990 to diet and physical activity.

    “McGinnis and Foege 96 reviewed the literature on the actual causes of death in the United States and attributed 14% of all deaths occurring in 1990 to diet and physical activity.”
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    Premisecitation

    Both adults and youth continue to consume less than the recommended levels of vegetables and fruit: Only 24.5% of adults and 21.4% of youth consume at least 5 servings each day.

    “Both adults and youth continue to consume less than the recommended levels of vegetables and fruit: Only 24.5% of adults and 21.4% of youth consume at least 5 servings each day.”
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    Premisecitation

    Doll later narrowed the estimate of cancer deaths attributable to diet to 35% (20% to 60%), still largely considering macronutrients and micronutrients rather than energy balance.

    “Doll 95 later narrowed the range of the estimate attributable to diet to 35% (20% to 60%), still largely considering macronutrients and micronutrients rather than energy balance.”
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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The proven benefit of weight loss and physical activity strongly suggests that lifestyle modification should be the first choice to prevent or delay diabetes and to more effectively manage disease in individuals with diabetes.

    “The proven benefit of weight loss and physical activity strongly suggests that lifestyle modification should be the first choice to prevent or delay diabetes and to more effectively manage disease in individuals with diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A nutritionally balanced diet plays an important role in maintaining a healthy weight and can have a favorable impact on blood pressure and plasma lipids.

    “good evidence indicates that a nutritionally balanced diet plays an important role in maintaining a healthy weight and can have a favorable impact on blood pressure 12 and plasma lipids.93”
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    Premisecitation

    Physical activity reduces the risk of breast and colon cancers and may reduce the risk of several other types of cancer.

    “Physical activity reduces the risk of breast and colon cancers and may reduce the risk of several other types of cancer.109 -113”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Dietary fat, which had remained stable since the mid-1980s, increased by 6% in 2000.

    “Dietary fat, which had remained stable since the mid-1980s, also increased by 6% in 2000.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Although there is widespread confusion about how the public should achieve energy balance, it is clear that balance between caloric intake and expenditure is the critical factor in maintaining a healthy BMI.

    “Although there is widespread confusion about how the public should achieve energy balance, it is clear that balance between caloric intake and expenditure is the critical factor in maintaining a healthy BMI.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    It has been estimated that 70% of type 2 diabetes risk in the United States is attributable to overweight and obesity and that each kilogram of weight gain over 10 years increases risk by 4.5%.

    “It has been estimated that 70% of type 2 diabetes risk in the United States is attributable to overweight and obesity and that each kilogram of weight gain over 10 years increases risk by 4.5%.”
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    Premisecitation

    Weight reduction, often achieved by the combination of reduced caloric intake and increased physical activity, has been shown to reduce the risk of diabetes and decrease insulin resistance, as well as to improve measures of glycemia and dyslipidemia in diabetics.

    “Weight reduction, often achieved by the combination of reduced caloric intake and increased physical activity, has been shown to reduce the risk of diabetes and decrease insulin resistance, as well as to improve measures of glycemia and dyslipidemia in diabetics.”
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    Interpretationreasoning

    For cancer, cardiovascular disease, and diabetes, screening for risk or early manifestations of disease can reduce incidence and mortality through recommendations for altered lifestyles, pharmacological interventions, treatment of precursor lesions, or earlier treatment of the disease itself.

    “For cancer, cardiovascular disease, and diabetes, screening for risk or early manifestations of disease can reduce incidence and mortality through recommendations for altered lifestyles, pharmacological interventions, treatment of precursor lesions, or earlier treatment of the disease itself.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    The Framingham Risk Score is the best available current approach for global risk assessment, and although it was derived from a specific geographic area and may not apply to all populations, its performance within subgroups has been assessed and is good.

    “The Framingham Risk Score is the best available current approach, and although it was derived from a specific geographic area and thus may not apply to all populations, its performance within subgroups has been assessed and is good.124,125”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Projected trends indicate a rising incidence and prevalence of diabetes, combined with an aging population and continuing rise in the prevalence of obesity.

    “Combined with an aging population and continuing rise in the prevalence of obesity, projected trends indicate a rising incidence and prevalence of diabetes.”
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    Premisecitation

    Favorable results from randomized trials conducted in the United States and Europe have established the value of routine screening with mammography, and repeated analysis and updates of individual trial data, as well as meta-analyses, have demonstrated the efficacy of mammography for reducing breast cancer deaths in women ages 40 to 69.

    “Favorable results from randomized trials conducted in the United States and Europe have established the value of routine screening with mammography, and over the past 3 decades repeated analysis and updates of individual trial data, as well as meta-analyses, have demonstrated the efficacy of mammography for reducing breast cancer deaths in women ages 40 to 69. 126,127”
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    Premisecitation

    Approximately 1 in 4 American adults has high blood pressure, defined as systolic pressure ≥140 mm Hg or diastolic pressure ≥90 mm Hg.

    “Approximately 1 in 4 American adults has high blood pressure, defined as systolic pressure Ն140 mm Hg or diastolic pressure Ն90 mm Hg. 12”
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    Interpretationreasoning

    Hypertension disparities translate into increased rates of stroke and heart disease death and a 4.2-times greater rate of end-stage kidney disease.

    “This translates into increased rates of stroke and heart disease death and a 4.2-times greater rate of end-stage kidney disease.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    If all screen-detectable cancers were diagnosed at a localized stage through regular screening, the 5-year relative survival rate would increase to about 95%.

    “If all of these cancers were diagnosed at a localized stage through regular screening, the 5-year relative survival rate would increase to about 95%.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Cancers that can be detected by screening account for half of all new cancer cases.
    • Rests on an assumption: The 5-year relative survival rate for screen-detectable cancers is about 84%.

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    Premisecitation

    Conventional risk factors account for the great majority of the risk that can be determined, and it is unusual to find patients with cardiovascular disease and none of the established risk factors.

    “the conventional risk factors account for the great majority of the risk that can be determined and that it is in fact unusual to find patients with cardiovascular disease and none of the established risk factors.123”
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    Premisecitation

    An estimated additional 45 million American adults fall into the prehypertensive range of 120 to 139/80 to 89.

    “An estimated additional 45 million fall into the “prehypertensive” range of 120 to 139/80 to 89. 17”
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    Premisecitation

    Elevated blood pressure is associated with a 2 to 3 times higher risk of developing congestive heart failure and substantially increases the risk of stroke, with blood pressures of 160 mm Hg systolic and/or 90 mm Hg diastolic or greater associated with a relative risk of stroke estimated at 4 times greater than in individuals without hypertension.

    “Elevated blood pressure is associated with a 2 to 3 times higher risk of developing congestive heart failure and substantially increases the risk of stroke, with blood pressures of 160 mm Hg systolic and/or 90 mm Hg diastolic or greater associated with a relative risk of stroke that has been estimated at 4 times greater than in individuals without hypertension.”
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    Premisecitation

    An estimated 30% of those with hypertension are unaware that they have it.

    “The prevalence of hypertension is increasing, and an estimated 30% of those with hypertension are unaware that they have it.12”
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    Premisecitation

    Moderate to vigorous activity for at least 45 minutes on 5 or more days per week may further reduce the risk of breast and colon cancers and also may reduce the risk of kidney, endometrial, and esophageal cancers.

    “Moderate to vigorous activity for at least 45 minutes on 5 or more days per week may further reduce the risk of breast and colon cancers and also may reduce the risk of kidney, endometrial, and esophageal cancers.110,111,113,119,120”
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    Premisecitation

    Excess body weight increases amounts of circulating estrogen, androgens, and insulin, all of which are associated with cell and tumor growth.

    “excess body weight increases amounts of circulating estrogen, androgens, and insulin, all of which are associated with cell and tumor growth.114”
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    Premisecitation

    Only about 34% of individuals with hypertension are on medication and have well-controlled blood pressure; 25% are on medication but have inadequate blood pressure control.

    “Only about 34% are on medication and have wellcontrolled blood pressure; 25% are on medication but have inadequate blood pressure control.12”
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    Premisecitation

    There are important disparities in the prevalence of hypertension, with blacks developing elevated blood pressure at an earlier age and having higher pressures on average.

    “There are important disparities in the prevalence of hypertension, with blacks both developing elevated blood pressure at an earlier age and having higher pressures on average.”
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    Premisecitation

    Strong direct and inferential evidence indicates that screening for colorectal cancer and adenomatous polyps reduces both mortality from and incidence of this disease.

    “Strong direct and inferential evidence indicates that screening for colorectal cancer and adenomatous polyps reduces both mortality from and incidence of this disease.130,131”
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    Premisenone given

    None of the prevention studies explicitly addressed the age at which screening should begin, the optimal frequency of screening, or other indications for screening.

    “None of the prevention studies explicitly addressed the age at which screening should begin, the optimal frequency of screening, or other indications for screening.”
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    Premisenone given

    Individuals with IFG, IGT, or undiagnosed diabetes are at high risk for cardiovascular disease.

    “because individuals with IFG, IGT, or undiagnosed diabetes are at high risk for cardiovascular disease, their identification should herald increased surveillance and treatment for hypertension, dyslipidemia, and tobacco use.”
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    Interpretationnone given

    Screening will detect not only cases of IFG or IGT but also cases of undiagnosed diabetes.

    “The case for screening is strengthened by the fact that screening will detect not only cases of IFG or IGT but also cases of undiagnosed diabetes.”
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    Premisenone given

    Considerable evidence supports the importance of avoiding tobacco use; increasing physical activity; maintaining a BMI <25 kg/m2; eating a nutritionally balanced diet; and getting screened for diabetes, cardiovascular disease, and cancer.

    “considerable evidence supports the importance of avoiding tobacco use; increasing physical activity; maintaining a BMI Ͻ25 kg/m 2 ; eating a nutritionally balanced diet; and getting screened for diabetes, cardiovascular disease, and cancer.”
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    Premisecitation

    No data support screening children for IFG or IGT, although there are recommendations for screening children for diabetes.

    “No data support screening children for IFG or IGT, although there are recommendations for screening children for diabetes.137”
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  • The paper relies on this without support.

    Elevated cholesterol levels are an important independent risk factor for coronary artery disease.

    “Elevated cholesterol levels have long been recognized as an important independent risk factor for coronary artery disease.”

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    Cancers that can be detected by screening account for half of all new cancer cases.

    “Cancers that can be detected by screening account for half of all new cancer cases.”

  • The paper relies on this without support.

    The 5-year relative survival rate for screen-detectable cancers is about 84%.

    “The 5-year relative survival rate for these cancers is about 84%.”

  • The paper relies on this without support.

    The prevalence of IFG or undiagnosed diabetes in adults increases greatly between ages 40 to 49 years and reaches a peak in people aged 60 to 74 years.

    “The prevalence of IFG or undiagnosed diabetes in adults increases greatly between ages 40 to 49 years and reaches a peak in people aged 60 to 74 years.”

  • The paper relies on this without support.

    Achieving energy balance and maintaining a healthy body weight are critical for the prevention and treatment of type 2 diabetes.

    “Achieving energy balance and maintaining a healthy body weight are critical for the prevention and treatment of type 2 diabetes, and limiting saturated fat intake can help to prevent the vascular complications of diabetes.”

  • The paper relies on this without support.

    Essential hypertension is manifest at varying ages and is usually asymptomatic.

    “because essential hypertension is manifest at varying ages and is usually asymptomatic, otherwise healthy patients need regular and ongoing blood pressure screening to determine when and if they become hypertensive, especially if opportunistic visits are infrequent.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Low-carbohydrate diets are usually low in fruits and vegetables, dairy products and whole grains; these dietary patterns, if maintained over the long term, are associated with an increased risk of a variety of chronic diseases, including hypertension and cancer.

    “Overall, low-carbohydrate diets are usually low in fruits and vegetables, dairy products and whole grains; these dietary patterns, if maintained over the long term, are associated with an increased risk of a variety of chronic diseases, including hypertension and cancer.12,16,68”

    From Diet in the management of weight loss (2006) · cites this paper as [68]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Individually, modifiable lifestyle factors are associated with lower risk of CHD.

    “Individually, these modifiable lifestyle factors are associated with lower risk of CHD, 12 but a combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.”

    From Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications (2006) · cites this paper as [12]

Cites

Flagged first, then by citations

1 of the 122 references couldn’t be matched to a known paper.

Research works printed but not linked: 33

  1. 2003, Natl Vital Stat Rep, 52, 1
  2. 1992, MMWR Morb Mortal Wkly Rep, 41, 529
  3. Ries L Eisner M Kosary C et al. SEER Cancer Statistics Review 1975–2000. Bethesda Md: US National Cancer Institute; 2003.
  4. 2003, MMWR Morb Mortal Wkly Rep, 52, 833
  5. 2002, MMWR Morb Mortal Wkly Rep, 51, 300
  6. 2003, MMWR Morb Mortal Wkly Rep, 52, 842
  7. International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking . Vol. 83. Oxford UK: Lyon International Agency for Research on Cancer; 2002. Available at: http://193.52.164.11/htdocs/monographs/vol83/02-involuntary.html.
  8. Silagy C Ketteridge S. The effectiveness of physician advice to aid smoking cessation. In: Database of Abstracts of Reviews of Effectiveness Update Software. Oxford UK: The Cochrane Library; 2004. The Cochrane Library Issue 2 2004.
  9. 1995, World Health Organ Tech Rep Ser, 854, 1
  10. 10.1161/circ.67.5.6219830 · DOI
  11. 10.1161/circ.100.13.1481 · DOI
  12. 10.1161/circ.96.9.3248 · DOI
  13. 10.1161/str.33.1.230 · DOI
  14. International Agency for Research on Cancer. Weight Control and Physical Activity. Oxford UK: Lyon International Agency for Research on Cancer; 2002. IARC Handbooks of Cancer Prevention ; vol 6.
  15. 10.1161/circ.102.18.2284 · DOI
  16. 1997, Family Economics and Nutrition Review, 10, 2
  17. 2004, MMWR Morb Mortal Wkly Rep, 53, 80
  18. 1992, Cancer Res, 52, 2024S
  19. 1997, Aging (Milano), 9, 2
  20. 2001, Med Sci Sports Exerc, 33, 762
  21. 10.1161/circ.103.1.163 · DOI
  22. 10.1161/circ.94.4.857 · DOI
  23. 10.1161/circ.96.1.355 · DOI
  24. 2001, Cancer Epidemiol Biomarkers Prev, 10, 287
  25. 1985, Natl Inst Health Consens Dev Conf Consens Statement, 5, 1
  26. 2001, MMWR Morb Mortal Wkly Rep, 50, 754
  27. 10.1161/circ.105.7.886 · DOI
  28. 10.1161/circ.104.4.491 · DOI
  29. 1979, Can Med Assoc J, 121, 1193
  30. 1986, J Fam Pract, 22, 341
  31. 1986, J Fam Pract, 22, 417
  32. 1986, J Fam Pract, 22, 511
  33. 1986, J Fam Pract, J Fam Pract, 23, 29

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Related

Authors
Eyre, H., Kahn, R., Robertson, R. M., the ACS/ADA/AHA Collaborative Writing Committee, ACS/ADA/AHA Collaborative Writing Committee Members, Clark, N. G., Doyle, C., Hong, Y., Gansler, T., Glynn, T., Smith, R. A., Taubert, K., & Thun, M. J.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2004-06-29
Volume
109
Issue
25
Pages
3244-3255
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.0000133321.00456.00
OpenAlex
W2136812326
Semantic Scholar
2009c3915d7c5bf328c7ab312cc4d1090c033034
Cited by
542
References
122
Citations by year
2026: 4 · 2025: 9 · 2024: 19 · 2023: 15 · 2022: 16 · 2021: 10 · 2020: 21 · 2019: 22 · 2018: 26 · 2017: 23 · 2016: 18 · 2015: 25 · 2014: 34 · 2013: 25 · 2012: 28
FWCI
40.75
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
cancer prevention, cardiovascular disease prevention, diabetes prevention, early detection, primary prevention, health promotion, tobacco use, diet, physical activity, cancer screening, health policy, economic cost of disease, inter-organizational collaboration
MeSH terms
Cardiovascular Diseases, Costs and Cost Analysis, Diabetes Mellitus, Health Promotion, Humans, Neoplasms, Primary Prevention, United States, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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