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Healthy lifestyle choices reap rewards

This recent report from the annual American Heart Association meeting underscores the important relationship between lifestyle choices and heart disease risks. We have known about the role of smoking, food choices, exercise and obesity in heart disease for some time, but this study shows the dramatic reduction in risk–82 percent–even moderate changes can make. Meir Stampfer, Frank Hu and their colleagues focused on five diet and lifestyle risk factors: smoking, body mass index, diet, exercise and alcohol consumption.

Stop smoking
The most dramatic finding in this study to me is the very high incidence of heart disease among smokers. About 50 percent of the 1,129 documented cases of heart disease were found to be among women who were current smokers. All of the lifestyle factors this group considered are important, but clearly, stopping smoking is head and shoulders above the others. If none of the other low risk behaviors were considered, nonsmokers enjoyed a 74 percent reduction in risk.

I see patients in our practice with heart disease in their 30s whose only risk factor is smoking. My overall recommendation would be to stop "cold turkey" as soon as you can, but anyone who has tried to quit understands it is not an easy task. Fortunately, there are some new medications that are proving helpful for some patients.

Originally developed for depression, bupropion hydrocloride (sold as Zyban^™ and Wellbutrin^™) is a prescription medication that reduces the urge to smoke among many people. Some long-time smokers are finding it possible to stop with the help of bupropion HCI combined with some of the nicotine patch or gum products.

Healthy weight
Maintaining a healthy weight for one’s height is also very important. Even among this study population comprised of health care professionals, obesity and lack of exercise were the two factors they were least likely to manage well. The study used a body mass index (BMI) of 25 or lower as the criteria for low risk. You can calculate your BMI by dividing your weight (in kilograms) by your height (in meters) squared.
[Go to HealthStatus.com to determine your own BMI.]

Losing weight isn’t easy, and many people think a new diet drug or fad diet is the magic bullet to permanent weight loss. It seldom is. I am a strong advocate of reducing the amount of calories you eat and increasing physical activity to achieve slow, consistent weight loss.

Exercise
Exercise is a fundamental component of weight management, and it also contributes to cardiovascular health, reducing blood pressure and improving circulation. The researchers in this study categorized women who exercised for 30 minutes or more a day either moderately or vigorously as low risk. If it’s unrealistic to exercise every day, a minimum of three days a week for 30 minutes provides some benefit.

What you should eat
What you eat may be as important as how much you eat. Those at low risk for developing heart disease in the Nurses’ Health Study were those whose diet included:

• a high percentage of cereal fiber;
• omega 3 fatty acids, found in such foods as salmon and tuna;
• folate, found in such foods as spinach, asparagus, brussel sprouts and orange juice; and
• polyunsaturated fats such as vegetable oils.

The American Heart Association recommends individuals reduce their total fat intake to no more 30 percent of total calories and reduce cholesterol intake to less than 300 milligrams per day.
[For detailed information about AHA nutritional guidelines, visit YNHH’s cardiac services diet section].

Wine for your heart
The fifth factor considered in the study is alcohol consumption. Low-risk women had an average of one half drink or more per day of an alcoholic beverage. I suggest to my patients who currently drink alcohol to consider red wine as an alternative to whatever they may be currently drinking.

Numerous studies have attributed the protective effects of alcohol consumption to an increase in HDL ("good") cholesterol levels. In addition, laboratory analyses found both red wine and grape juice to be especially high in two flavonoids, quercetin and rutin, which reduce the stickiness of blood platelets, increasing blood flow.

Since some people may not tolerate alcohol well, I do not recommend anyone begin drinking to minimize their risk of heart disease. The other four factors–quitting smoking, maintaining a healthy weight, exercising and eating healthfully are more important.

This study is important on several levels. It points out that huge benefits can be gained by only moderate changes. We don’t need to become vegetarians or marathon runners to protect our health. Consistent, moderate lifestyle changes can make a difference in protecting yourself from a disease that affects nearly 60 million Americans.

Dr. Freed is a cardiologist and an associate with The Cardiology Group with offices in New Haven and Branford. She is an attending physician at Yale-New Haven Hospital.