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Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications
Open accessAbstract
Background— Healthy lifestyle choices such as eating a prudent diet, exercising regularly, managing weight, and not smoking may substantially reduce coronary heart disease (CHD) risk by improving lipids, blood pressure, and other risk factors. The burden of CHD that could be avoided through adherence to these modifiable lifestyle factors has not been assessed among middle-aged and older US men, specifically men taking medications for hypertension or hypercholesterolemia. Methods and Results— We prospectively monitored 42 847 men in the Health Professionals Follow-up Study, 40 to 75 years of age and free of disease in 1986. Lifestyle factors were updated through self-reported questionnaires. Low risk was defined as (1) absence of smoking, (2) body mass index <25 kg/m 2 , (3) moderate-to-vigorous activity ≥30 min/d, (4) moderate alcohol consumption (5 to 30 g/d), and (5) the top 40% of the distribution for a healthy diet score. Over 16 years, we documented 2183 incident cases of CHD (nonfatal myocardial infarction and fatal CHD). In multivariate-adjusted Cox proportional hazards models, men who were at low risk for 5 lifestyle factors had a lower risk of CHD (relative risk: 0.13; 95% confidence interval [CI]: 0.09, 0.19) compared with men who were at low risk for no lifestyle factors. Sixty-two percent (95% CI: 49%, 74%) of coronary events in this cohort may have been prevented with better adherence to these 5 healthy lifestyle practices. Among men taking medication for hypertension or hypercholesterolemia, 57% (95% CI: 32%, 79%) of all coronary events may have been prevented with a low-risk lifestyle. Compared with men who did not make lifestyle changes during follow-up, those who adopted ≥2 additional low-risk lifestyle factors had a 27% (95% CI: 7%, 43%) lower risk of CHD. Conclusions— A majority of CHD events among US men may be preventable through adherence to healthy lifestyle practices, even among those taking medications for hypertension or hypercholesterolemia.
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TL;DR
In 42,847 US male health professionals followed for 16 years, adherence to five low-risk lifestyle factors was associated with substantially lower coronary heart disease (CHD) risk, and 62% of coronary events may have been preventable. The inverse association persisted among men taking antihypertensive or lipid-lowering medications, with a population-attributable risk of 57%.
Key findings
- Over 16 years, 2,183 incident CHD cases occurred. Men at low risk for all 5 lifestyle factors had an RR of 0.13 (95% CI: 0.09, 0.19) compared with men at low risk for none; the population-attributable risk was 62% (95% CI: 49%, 74%).
- Among users of lipid-lowering or antihypertensive medications, the population-attributable risk for all 5 low-risk factors was 57% (95% CI: 32%, 79%); among nonusers it was 66% (95% CI: 49%, 79%). By age, population-attributable risk was 79% (95% CI: 61%, 90%) for men <65 years and 47% (95% CI: 27%, 68%) for men ≥65 years.
- Men who adopted ≥2 additional low-risk lifestyle factors during follow-up had an RR of 0.73 (95% CI: 0.57, 0.93) compared with men who did not change; men who reduced their score by ≥2 factors had an RR of 1.48 (95% CI: 1.15, 1.88).
- In multivariate models including all lifestyle factors, low-risk categories were independently associated with lower CHD risk: not currently smoking RR 0.47 (95% CI: 0.42, 0.54), BMI <25 kg/m² RR 0.70 (95% CI: 0.64, 0.77), exercise ≥3.5 h/wk RR 0.83 (95% CI: 0.74, 0.92), diet score top 40% RR 0.84 (95% CI: 0.77, 0.92), and alcohol 5–30 g/d RR 0.79 (95% CI: 0.73, 0.87).
Methods
- Prospective cohort study of 42,847 men in the Health Professionals Follow-up Study, aged 40–75 years and free of disease in 1986, followed through January 31, 2002. Lifestyle factors were updated through biennial questionnaires, with diet assessed every 4 years by a 131-item food frequency questionnaire.
- Low risk was defined as not currently smoking, BMI <25 kg/m², moderate-to-vigorous activity ≥30 min/d, moderate alcohol intake (5–30 g/d), and a diet score in the top 40% of the cohort’s Alternate Healthy Eating Index distribution. A healthy lifestyle score summed the number of low-risk factors (0–5).
- Cox proportional hazards models estimated relative risks, adjusted for age, calendar year, parental history of MI, history of hypertension, history of hypercholesterolemia, aspirin use, and antihypertensive medication use. Population-attributable risks were calculated, and change in lifestyle was analyzed among 33,759 men who completed baseline and at least one follow-up questionnaire.
Limitations
- The paper states it was observational, not a clinical trial; self-reported measurement error is inevitable and likely nondifferential, which would attenuate true relative risks. It also notes that only 4% of men adopted all healthy practices, that the healthiest men could not increase their score by 2 factors, and that the cohort was healthier than the general US male population.
- Evident from the text and tables: the medication subgroup analyses had few cases, especially for lipid-lowering medication users at low risk for all 5 factors (3 cases; RR 0.31, 95% CI: 0.07, 1.30), making those estimates imprecise.
- Evident from the text: the cohort consisted of highly educated male health professionals, so findings may not generalize to other populations.
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38 Own result · 17 Not checked yet · 9 Own interpretation · 8 Own method · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each lifestyle factor, we observed an inverse association with risk of CHD, which remained significant when all 5 lifestyle factors were included in the same model (Table 1).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In multivariate-adjusted Cox proportional hazards models, men who were at low risk for 5 lifestyle factors had a lower risk of CHD (relative risk: 0.13; 95% confidence interval [CI]: 0.09, 0.19) compared with men who were at low risk for no lifestyle factors.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
plaincorrelationaln = 2,183- Asserted: passes — The authors put it forward as true.
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In the paper
“Among these medication users (and also among nonusers), the healthy lifestyle score was significantly inversely associated with risk of CHD (Figure 2).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“When categorized as a dichotomous variable, being at low risk for each lifestyle factor was still significantly and independently associated with lower risk.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, the healthy lifestyle score was significantly inversely associated with risk of CHD (P for trend, Ͻ0.0001) (Figure 1).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Men at low risk for Ն1 lifestyle factor had a significantly lower risk of CHD, compared with men at low risk for none of the 5 factors.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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In the paper
“Among men taking medication for hypertension or hypercholesterolemia, 57% (95% CI: 32%, 79%) of all coronary events may have been prevented with a low-risk lifestyle.”
- Also stated in: § Results · plain
“Among medication users, the population-attributable risk for adhering to all 5 low-risk lifestyle practices was 57% (95% CI: 32%, 79%) (Table 3).”
- Also stated in: § Discussion · plain
“In our cohort, the population-attributable risk for men at low risk for all 5 lifestyle factors was 57% among the users of cardiovascular medications.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixty-two percent (95% CI: 49%, 74%) of coronary events in this cohort may have been prevented with better adherence to these 5 healthy lifestyle practices.”
- Also stated in: § Results · hedged
“This translates to a population-attributable risk of 62% (95% CI: 49%, 74%), suggesting that a majority of coronary disease in this population may be attributed to poor adherence to a healthy lifestyle.”
- Also stated in: § Discussion · hedged
“In this population of male health professionals, 62% of all coronary events may have been avoided had all men adhered to a low-risk lifestyle of not smoking, exercising regularly, eating prudently, consuming alcohol in moderation, and maintaining a healthy weight.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
hedgedconditionaln = 2,183- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
- Also stated in: § Results · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared with men who did not make lifestyle changes during follow-up, those who adopted Ն2 additional low-risk lifestyle factors had a 27% (95% CI: 7%, 43%) lower risk of CHD.”
- Also stated in: § Results · plain
“Men who adopted at least 2 new healthy characteristics during follow-up had a relative risk of 0.73 (95% CI: 0.57, 0.93) compared with men who did not change, controlling for the number at baseline (Table 4).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Men at low risk for all 5 factors had the lowest risk.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“On the other hand, men who reduced their healthy lifestyle score by 2 or more factors had a relative risk of 1.48 (95% CI: 1.15, 1.88), compared with men who did not change.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Even among older men (Ն65 years), healthy lifestyle factors were associated with significantly lower risk.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The rate of incident CHD in this population (2.86 events/1000 personyears) was almost half of the age-standardized rate seen in the Atherosclerosis Risk in Communities (ARIC) study population (5.53 events/1000 person-years 39 ), the participants of which were selected to be representative of adults in 4 communities across the United States.40”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Men in the low-risk group for all 5 lifestyle practices, only 4% of the population, had an RR of 0.37 (95% CI: 0.26, 0.53), compared with the remaining men in the population.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The population-attributable risk for adhering to all 5 low-risk lifestyle practices was much higher among middle-aged men (Ͻ65 years old) (population-attributable risk: 79%; 95% CI: 61%, 90%) than among men 65 years or older (populationattributable risk: 47%; 95% CI: 27%, 68%) (Table 3).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Even though the men in our cohort were healthier than men in the United States, only 4% of men met the low-risk criteria for all 5 characteristics.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“No (79%) 1404 20 4 0.34 (0.22-0.53) 66 (49-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Lipid-lowering medications (27%) ¶ 165 3 5 0.31 (0.07-1.30) 68 (21-94)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Increase by Ն2 | 4 | 76 | 0.73 (0.57-0.93)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Ͻ65 years old (71%) 1023 8 4 0.20 (0.10-0.40) 79 (61-90)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Ͼ65 years old (29%) 1160 23 4 0.52 (0.34-0.79) 47 (27-68)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Decrease by Ն2 | 5 | 81 | 1.48 (1.15-1.88)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Low risk (Ͻ25 vs Ն25 kg/m 2 ) | 740 | 43 | 0.68 (0.62-0.75) | 0.70 (0.64-0.77)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Lipid-lowering medications (27%) ¶ 165 3 5 0.31 (0.07-1.30) 68 (21-94)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Low risk (Ն3.5 vs Ͻ3.5 h/wk) | 462 | 29 | 0.72 (0.65-0.80) | 0.83 (0.74-0.92)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Yes (21%) 779 11 4 0.42 (0.23-0.77) 57 (32-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Ͼ65 years old (29%) 1160 23 4 0.52 (0.34-0.79) 47 (27-68)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Low risk (5-30 g/d vs others) | 738 | 40 | 0.77 (0.70-0.84) | 0.79 (0.73-0.87)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Antihypertensive medications (84%) ¶ 699 10 3 0.45 (0.24-0.85) 54 (27-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Antihypertensive medications (84%) ¶ 699 10 3 0.45 (0.24-0.85) 54 (27-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Low risk (score Ն42.4 vs Ͻ42.4) | 795 | 40 | 0.75 (0.69-0.82) | 0.84 (0.77-0.92)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“No (79%) 1404 20 4 0.34 (0.22-0.53) 66 (49-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“P value for trend | | | Ͻ0.0001”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Yes (21%) 779 11 4 0.42 (0.23-0.77) 57 (32-79)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Low risk (not current vs current) | 1861 | 91 | 0.45 (0.40-0.51) | 0.47 (0.42-0.54)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Ͻ65 years old (71%) 1023 8 4 0.20 (0.10-0.40) 79 (61-90)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In an older Mediterranean population (70 to 90 years), risk of CHD mortality was 65% lower among participants who committed to 4 healthy lifestyle choices.14”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
What the sources say
- Not checked yetcites [14] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“We calculated body mass index (BMI [kg/m 2 ]) by using self-reported measures of height and weight, which have been validated in a subset of this cohort.16”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
What the sources say
- Not checked yetcites [16] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We still conclude that a majority of cases of CHD among this low-risk population of men may have been prevented through a healthy lifestyle.”
- Also stated in: § Additional information · hedged
“A majority of coronary events in this population of men may have been prevented through better adherence to a low-risk lifestyle.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The observed associations between low-risk lifestyle factors and CHD are causal.
- Also stated in: § Additional information · hedged
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, we could not capture the benefit among men who met the threshold for low risk but continued to improve their lifestyle.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The reproducibility and validity of these FFQs are high when compared with multiple 1-week diet records and biochemical markers.18 -20”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Summary results from the National Health Interview Survey [41][42][43][44] indicate that fewer men in the United States Ն45 years of age met our low-risk criteria for exercise (16% versus 29% in our cohort), optimal BMI (37% versus 43%), absence of current smoking (84% versus 91%), and moderate alcohol consumption (19% versus 40%).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
What the sources say
- Not checked yetcites [41][42][43][44]
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We probably underestimated the true benefit of healthy changes, as the men who were the healthiest (those with 4 or 5 low-risk lifestyle factors) could not increase their score by 2 factors.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The AHEI, which targets foods and nutrients associated with lower risk of chronic disease, better predicts chronic disease risk than do other measures of diet quality, including the HEI.21,23”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The risk of CHD among former smokers declines after smoking cessation, approximating the risk of those who have never smoked after 10 to 14 years.24”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
What the sources say
- Not checked yetcites [24] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The population-attributable risk resulting from low-risk lifestyle practices within this population of men was lower than expected.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
- Rests on an assumption: A combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study shows the extent to which healthy lifestyle changes may lower the risk of CHD, even during middle age or later in life.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This implies that more than half of the cases of CHD among the medication users in this population may have been avoided by adherence to low-risk lifestyle practices, in addition to the benefits seen from medication use.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
- Rests on an assumption: A combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.
- Rests on an assumption: Coronary disease remains elevated among users of antihypertensive and lipid-lowering medications.
None of the sources cited for this claim have been checked yet.
In the paper
“Although the accuracy of self-reported data within this population of motivated and educated health professionals has been well documented, 16 -19”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
What the sources say
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Conclusions-A majority of CHD events among US men may be preventable through adherence to healthy lifestyle practices, even among those taking medications for hypertension or hypercholesterolemia.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: A causal relation exists between low-risk lifestyle practices and risk of CHD.
- Rests on an assumption: A combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.
- Rests on an assumption: Coronary disease remains elevated among users of antihypertensive and lipid-lowering medications.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Further adjustment for lipid-lowering medications did not appreciably alter the results.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“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.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Clinical Perspective p 167
What the sources say
- Not checked yetcites [12] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The addition of healthy behaviors, such as a prudent diet and regular exercise, to either antihypertensive or lipid-lowering drug therapy in other populations reduced risk factors, such as systolic and diastolic blood pressure 33,34 and low-density lipoprotein cholesterol, 35 as well as the inflammatory biomarker C-reactive protein, 36 compared with drug therapy alone.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A healthy lifestyle can be an effective, nonpharmacological approach to reducing coronary heart disease among men.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The observed associations between low-risk lifestyle factors and CHD are causal.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In conclusion, a healthy lifestyle plays an important role in the primary prevention of CHD in middle-aged and older men, even among men on antihypertensive or lipid-lowering medication.”
- Also stated in: § Additional information · plain
“This low-risk lifestyle was also associated with lower risk of coronary heart disease among men taking antihypertensive and lipid-lowering medications.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The observed associations between low-risk lifestyle factors and CHD are causal.
- Also stated in: § Additional information · plain
- The quote only partly states this claim. 3
- Probably not a substantial claim. 11
- It may state two separate claims as one. 7
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Over 16 years, we documented 2183 incident cases of CHD (nonfatal myocardial infarction and fatal CHD).”
- Also stated in: § Results · plain
“After 16 years of follow-up, we documented 2183 incident coronary events.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
plainn = 2,183- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
- Also stated in: § Results · plain
None of the sources cited for this claim have been checked yet.
In the paper
“The average HEI score of 68.3, within this cohort, 45 is slightly higher than the mean HEI score of 65.2 among US men 51 years or older.46”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
What the sources say
- Not checked yetcites [45] source
- Not checked yetcites [46]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“P for trend, Ͻ0.0001.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“P for trend, Ͻ0.0001 for both users and nonusers of medication.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using Cox proportional hazards models adjusted for age, calendar year, parental history of MI, history of hypertension, history of hypercholesterolemia, aspirin use, and antihypertensive medication use.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Little is known about the relation between combined healthy lifestyle choices and incident CHD among middle-aged and older men, especially those who are reducing their risk by using drugs for hypertension or hypercholesterolemia.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Clinical Perspective p 167
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Pharmacological therapies, including lipidlowering and antihypertensive medications, are efficacious in lowering some of these risk factors, 2,3 typically reducing cardiovascular disease risk by 20% to 30%.2,4”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Abstract
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because diagnosis of diabetes, angina, hypertension, hypercholesterolemia, or revascularization surgery may lead to changes in diet, we stopped updating dietary information after new diagnoses of these outcomes during follow-up.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Statistical Analysis
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Healthy diet and other lifestyle practices, including not smoking, maintaining a healthy weight, and exercising daily, also improve these clinical risk factors as well as reduce inflammation, homocysteine, glucose intolerance, and arrhythmias.[5][6][7][8][9][10][11]”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Clinical Perspective p 167
What the sources say
- Not checked yetcites [5][6][7][8][9][10][11]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Clinical Perspective p 167
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“We used the cumulative average of the AHEI-based diet score from repeated dietary assessments to represent long-term dietary information and minimize within-person variation.29”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Statistical Analysis
What the sources say
- Not checked yetcites [29] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We used both confirmed and probable cases, as results were similar when we excluded probable cases (17% of cases).”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Outcome Ascertainment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This is consistent with guidelines for moderate alcohol consumption, 26 although higher amounts of alcohol intake are associated with lower risk of CHD.27”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
What the sources say
- Not checked yetcites [27] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Participants reported the average time engaged in specific activities biennially, using an activity questionnaire previously validated within a subset of this cohort.17”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Exposure and Covariate Ascertainment
What the sources say
- Not checked yetcites [17] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The observational design and repeated measures of diet and lifestyle allowed us to assess the consequences of changes in multiple lifestyle factors, which generally occur in free-living populations.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For individuals missing information on any lifestyle factor, we carried forward information from the previous questionnaire, when available.Men with residual missing values were placed in the high-risk category, to give the most conservative estimate.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In our analysis, we estimated the impact of multiple lifestyle factors simultaneously, which would be difficult if not impossible to study in a trial with 16 years of follow-up.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because of the prospective design of the study, this misclassification should be nondifferential with respect to disease status and would attenuate the true relative risk.”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Measurement error in self-reported variables is inevitable.
The authors state this as an assumption.
A causal relation exists between low-risk lifestyle practices and risk of CHD.
“assuming a causal relation between the low-risk lifestyle practices and risk of CHD.”
The paper relies on this without support.
A combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.
“but a combination of healthy lifestyle choices has a greater impact than any single lifestyle factor.”
The paper relies on this without support.
Coronary disease remains elevated among users of antihypertensive and lipid-lowering medications.
“but coronary disease remains elevated in this population.”
The paper relies on this without support.
Measurement error in self-reported variables is inevitable.
“measurement error in selfreported variables is inevitable.”
The paper relies on this without support.
The observed associations between low-risk lifestyle factors and CHD are causal.
“A randomized clinical trial is ideal to establish causality of these lifestyle factors on risk of CHD.”
“We still conclude that a majority of cases of CHD among this low-risk population of men may have been prevented through a healthy lifestyle.”
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?
In the citing paper
“Among populations with traditional healthy lifestyle behaviors, the prevalences of obesity, dyslipidemia, hypertension, and diabetes mellitus are far less than in industrialized populations, even after adjustment for age.49 -52”
From Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease (2008) · cites this paper as [49]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Discussion
“Ͼ65 years old (29%) 1160 23 4 0.52 (0.34-0.79) 47 (27-68)”
§ Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications > Results
“among men 65 years or older (populationattributable risk: 47%; 95% CI: 27%, 68%)”
Citations
Cites
Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200101043440101 · Cited by 5,638
Self-citationCardiovascular Survey Methods.
Rose, G., & Blackburn, H. (1968) · Annals of Internal Medicine · doi:10.7326/0003-4819-69-6-1335_2 · Cited by 3,090
de Lorgeril, M., Salen, P., Martin, J.-L., Monjaud, I., Delaye, J., & Mamelle, N. (1999) · Circulation · doi:10.1161/01.cir.99.6.779 · Cited by 2,910
Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., Berra, K., Blair, S. N., Costa, F., Franklin, B., et al. (2003) · Circulation · doi:10.1161/01.cir.0000075572.40158.77 · Cited by 2,132
Rimm, E. B., Giovannucci, E. L., Stampfer, M. J., Colditz, G. A., Litin, L. B., & Willett, W. C. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116211 · Cited by 2,104
Self-citationPrimary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle
Stampfer, M. J., Hu, F. B., Manson, J. E., Rimm, E. B., & Willett, W. C. (2000) · New England Journal of Medicine · doi:10.1056/nejm200007063430103 · Cited by 1,794
Self-citationKennedy, E., Ohls, J. C., Carlson, S. J., & Fleming, K. E. (1995) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(95)00300-2 · Cited by 1,626
Optimal Diets for Prevention of Coronary Heart Disease
Hu, F. B. (2002) · JAMA · doi:10.1001/jama.288.20.2569 · Cited by 1,503
Rimm, E. B., Williams, P., Fosher, K., Criqui, M., & Stampfer, M. J. (1999) · BMJ · doi:10.1136/bmj.319.7224.1523 · Cited by 1,360
Self-citation
Cited by
Sorted by citations
Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., Greenlund, K., Daniels, S., Nichol, G., Tomaselli, G. F., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.192703 · Cited by 4,750
Self-Determination Theory Applied to Health Contexts: A Meta-Analysis
Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012) · Perspectives on Psychological Science · doi:10.1177/1745691612447309 · Cited by 1,959
Anderson, T. J., Grégoire, J., Pearson, G. J., Barry, A. R., Couture, P., Dawes, M., Francis, G. A., Genest, J., Grover, S., Gupta, M., et al. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.07.510 · Cited by 1,173
“Second, CV risk scoring strategies tend to be better calibrated among middle-aged individuals because traditional CV risk factors, such as dyslipidemia, are most strongly associated with premature CVD. 8,9 It has been estimated that many younger individuals (especially those with elevated LDL-C levels) will bene fi t s…”
ResultInfluentialSalt intakes around the world: implications for public health
Brown, I. J., Tzoulaki, I., Candeias, V., & Elliott, P. (2009) · International Journal of Epidemiology · doi:10.1093/ije/dyp139 · Cited by 1,173
Handbook of Religion and Health
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · doi:10.1093/oso/9780190088859.001.0001 · Cited by 1,160
Metadata
- Authors
- Chiuve, S. E., McCullough, M. L., Sacks, F. M., & Rimm, E. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2006-07-11
- Volume
- 114
- Issue
- 2
- Pages
- 160-167
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2000745019
- Semantic Scholar
- b513e2a44d4288b1919efb6b7438116f4d21ab0a
- Cited by
- 477
- References
- 50
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 12 · 2023: 59 · 2022: 30 · 2021: 17 · 2020: 23 · 2019: 16 · 2018: 29 · 2017: 19 · 2016: 23 · 2015: 13 · 2014: 27 · 2013: 20 · 2012: 35
- FWCI
- 18.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL07575, R01HL035464, HL35464, T32HL007575)
- 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, healthy lifestyle, men, middle-aged and older adults, antihypertensive drugs, smoking, physical activity, alcohol consumption, body mass index, diet, myocardial infarction, modifiable risk factors, Health Professionals Follow-up Study
- MeSH terms
- Antihypertensive Agents, Hypolipidemic Agents, Coronary Disease, Drug Therapy, Combination, Health Personnel, Humans, Life Style, Male, Myocardial Infarction, Risk, United States, Incidence
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.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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