Better health through better lifestyle [Aug 2000; 78-3]

Better health through better lifestyle
Study Results Comment Ten lifestyle tips

Bandolier has reported previously on the major prospective study of 122,000 nurses in the USA, on folate and colon cancer ( Bandolier 60 ) and walking and heart disease ( Bandolier 68 ). The study has also looked at a number of other links between healthy living and health outcomes.

The big question, though, is whether combing all the different aspects of healthy living makes a substantial difference to health outcomes. Put in a personal way, if Bandolier were to give up smoking, start drinking, lose weight, eat properly and take some exercise, would it make any difference? The answer seems to be that it would not only make a difference, but reduce the chance of heart attack or stroke by about 80% over 14 years or so [1].

Study

The US Nurses' health study is a cohort of 122,000 female nurses aged 30 to 55 years in 1976, and who have been followed prospectively with bi-annual questionnaires to update information on known or suspected risk factors. This analysis examined the benefits (or otherwise) of lifestyles that combined several features individually known to affect risk of heart disease. Women considered at low risk had the following features:

Diet: if they scored in the highest 40% of the cohort on a composite measure based on a diet low in trans fat and glycaemic load (extent to which blood sugar may be raised), high in fibre, marine fatty acids, folate and high ratio of polyunsaturated to saturated fat.
Body mass index: a body mass index (weight in kg divided by the square of the height in metres) of less than 25.
Physical activity: took 30 minutes of vigorous or moderate activity a day, including brisk walking.
Alcohol consumption: consumed an average of 5 g of alcohol a day, equivalent to about half a glass of wine.
Smoking: never smoked or stopped smoking.

Results

In 14 years of follow up, there were 1128 heart attacks and 705 strokes. The more low risk factors you have in your lifestyle, the lower your risk of heart attack or stroke (Figure and Table). The implications are that in women 82% of heart attacks (95% CI 58% to 93%) and 74% of heart attacks or strokes (55% to 86%) are preventable by having a good lifestyle.

Figure and Table: Effect of low risk factor lifestyle on risk of coronary or cardiovascular events (heart attack plus stroke)

			Relative risk (95% CI)
Group		Percentage of women	Coronary events	Coronary events or stroke
Three low risk factors	Good diet Nonsmoking Enough exercise	12.7	0.43 (0.33 to 0.55)	0.46 (0.37 to 0.55)
Four low risk factors	Good diet Nonsmoking Enough exercise Body mass index low	7.2	0.34 (0.23 to 0.52)	0.38 (0.28 to 0.51)
Five low risk factors	Good diet Nonsmoking Enough exercise Body mass index low Enough alcohol	3.1	0.17 (0.07 to 0.41)	0.25 (0.14 to 0.44)
Risks calculated with reference to all other women

Comment

Only a limited set of variables were considered, but they are variables that any individual can control. We can choose to stop smoking or not smoke. We can choose to have a good diet. We can choose to take sufficient exercise. We can choose to lose weight, or ensure that our weight remains appropriate to our height. We can choose to drink a moderate amount of alcohol (at least some of us can, as this would be impossible for certain devout religious groups).

The bottom line is that we can choose to put ourselves in the way of heart attacks or strokes, or by behaviour avoid them. The same behaviour is also likely to reduce the risk of cancer, and perhaps other diseases. How to lead a healthy life is something that Bandolier is asked increasingly. For our own convenience we have drafted a simple 10-point plan for this, and we reproduce it in the box. It is based on studies of high quality carried in Bandolier .

This sheet is a quick summary of ten lifestyle tips to help avoid seeing a doctor about heart disease or cancer, based on good quality information. For more details, see the healthy living pages off the Bandolier home page at www.ebandolier.com. This is also available as a downloadable and PDF

Eat whole grain foods (bread, or rice, or pasta) on four occasions a week. This will reduce the chance of having almost any cancer by 40%. Given that cancer gets about 1 in 3 of us in a lifetime, that's big advice.
Don't smoke. If you do smoke, stop. Nicotine patches, gum or inhaler won't help much, and acupuncture won't help at all. Try to reduce your smoking, as there is a profound dose-response (the more you smoke, the more likely you are to have cancer, or heart or respiratory disease). So cut down to below five cigarettes a day and leave long portions of the day without a cigarette.
Eat at least five portions of vegetables and fruit a day, and especially tomatoes (including ketchup), red grapes and the like, as well as salad all year. This protects against a whole variety of different nasty things:
• It reduces the risk of stroke dramatically
• It reduces the risk of diabetes considerably
• It will reduce the risk of heart disease and cancer.
Use Benecol instead of butter or margarine. It really does reduce cholesterol, and reducing cholesterol will reduce the risk of heart attack and stroke even in those whose cholesterol is not particularly high.
Drink alcohol regularly. The type of alcohol probably doesn't matter too much, but the equivalent of a couple of glasses of wine a day or a couple of beers is a good thing. The odd day without alcohol won't hurt either. Think of it as medicine.
Eat fish. Eating fish once a week won't stop you having a heart attack in itself, but it reduces the likelihood of you dying from it by half.
Take a multivitamin tablet every day, but be sure that it is one with at least 200 micrograms of folate. The evidence is that this can substantially reduce chances of heart disease in some individuals, and it has been shown to reduce colon cancer by over 85%. It may also reduce the likelihood of developing dementia. Folate is essential in any woman contemplating pregnancy because it will reduce the chance of some birth defects.
If you are pregnant or have high blood pressure, coffee is best minimised. For the rest of us drinking four cups of coffee a day is likely to reduce our chances of getting colon cancer and Parkinson's disease.
Get breathless more often. You don't have to go to a gym or be an Olympic marathon runner. Simply walking a mile a day, or taking reasonable exercise three times a week (enough to make you sweat or glow) will substantially reduce the risk of heart disease. If you walk, don't dawdle. Make it a brisk pace. One of the benefits of regular exercise is that it strengthens bones and keeps them strong. Breaking a hip when elderly is a very serious thing.
Check your height and weight on a chart to see if you are overweight for your height. Your body mass index is the weight in kilograms divided by the height in metres squared: for preference it should be below 25. If you are overweight, lose it. This has many benefits. There is no good evidence on simple ways to lose weight that work. Crash diets don't work. Take it one step at a time, do the things that are possible now, and combine some calorie limitation with increased exercise. The good news is that in a few years time we may have some appetite suppressants to make it easier.

Reference:

MJ Stampfer et al. Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine 2000 343: 16-22.

previous or next story in this issue