5 Ways to Prevent a First Heart Attack

Diet and lifestyle - not genetics - play the greatest role

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Whether your father, mother or siblings have had heart disease may seem like the most important predictor of your own chances of a heart attack.  Not so – says a large Swedish study published in the Journal of the American College of Cardiology in 2014.  In fact, it showed that 5 specific lifestyle factors like eating right, regular exercise and quitting smoking can combine to prevent 80% of first heart attacks.

The researchers, from the Karolinska Institute in Stockholm, set out to determine to what degree healthy habits individually - or in concert - help adults avoid a future heart attack, or myocardial infarction.

Rates of coronary heart disease have dropped in many parts of the world, write the authors, thanks to advances in medications that work to fight high blood pressure and lower cholesterol.  Since huge populations are at risk of cardiovascular disease, however, the use of prescription drugs - with their own risks of side effects and significant cost if taken over the long term - are not an effective wide-scale preventative strategy, argue the researchers.  They write that their own past research on women and that of other scientists on both genders shows lifestyle changes can dramatically cut heart attack risk.

What the study examined:  Men between the ages of 45 and 79 were recruited in 1997, and surveyed about their eating and activity habits, along with data including their weight, family history of heart disease, and level of education.

  A total of 20,721 men without any history of cardiovascular disease, cancer, or diabetes were then tracked over an 11-year period.

Five diet and lifestyle factors were examined: diet, smoking habits, alcohol consumption, belly fat and daily activity level. 

What the researchers discovered:  Each of the five lifestyle habits or conditions was found to offer its own individual benefit in preventing a future heart attack.

  The best odds were found among men adhering to all five - reaping an 80% reduction in heart attack risk - although only 1% of the study population was in this category.

Here's how the habits ranked according to heart attack protection:

1.   Quitting smoking (36% lower risk):  Consistent with extensive previous research, quitting smoking is one of the top longevity-threatening habits you should abandon.  In this Swedish trial, men who had either never smoked, or quit at least 20 years prior to the beginning of the study enjoyed a 36% lower chance of a first heart attack.

This jives with findings of many previous investigations including the Million Women Study in the UK, in which almost 1.2 million women were tracked over a 12-year period. That longitudinal research found that quitting by the age of 30 or 40 reaped an extra 11 years of life on average, thanks not only to fewer heart attacks, but less cancer and respiratory disease as well.

    2.   Eating a nutritious diet (20% lower risk):  Again, no surprise that a healthy plant-based diet can help ward off a heart attack (and other age-related diseases like diabetes and cancer).  The Swedish study characterized a healthy diet using the Recommended Food Score from the National Health and Nutrition Examination Survey (NHANES) in the US, which is "strongly predictive of mortality" and includes the following:

    • At least 5 servings of fresh vegetables and fruits each day
    • 4 servings of whole grains
    • 1 or more servings of reduced-fat dairy
    • Weekly consumption of about two servings of healthy fish

    Those subjects who followed these guidelines most closely had a 20% lower risk of a first heart attack, even if they also ate foods from the "non-recommended" list such as red and processed meat, refined cereals and sweets.

    3.   Getting rid of belly fat (12% lower risk):  Increasingly, epidemiologists are finding waist circumference and waist-to-hip ratio to be a better predictor of ill health than sheer body weight, especially when it comes to abdominal fat that surrounds your internal organs (visceral fat) and not just the pudge that sits under the skin of your belly making your waistband too tight.

    Indeed, subjects in this Swedish study whose waistlines measured less than 95 cm (about 38") over the course of the trial, had a 12% lower risk of a first heart attack compared with men with more belly fat.

    4.   Drinking only in moderation (11% lower risk):  In this study, drinking in moderation cut the risk of a first heart attack by about 11%.  This is in line with very consistent evidence that consuming alcohol in moderation reduces the risk of cardiovascular disease, including heart attacks and stroke.

    Still, the researchers offer certain reservations about alcohol's benefits, since as soon as consumption goes beyond light-to-moderate intakes of 1-2 drinks per day, there are far more hazards than benefits to health in the form of heart disease, cancer and accidents.

    To recap: people who drink in moderation may be healthier than teetotalers, but only if they drink in moderation.

    5.   Being physically active (3% reduction in risk):  Men who walked or cycled 40 minutes per day, and exercised at least one hour per week were found to have a 3% lower risk of a first heart attack in this study.  That number is surprisingly low, considering other evidence that exercise is very beneficial for heart health.  Still, exercise has such strong benefits not only for your cardiovascular system, but towards strengthening your bones, your respiratory system, helping ward off dementia and also stress relief (not to mention avoiding the hazards of sitting still), it should not be considered a fringe health strategy.  The more you move, the better.

    Wait - didn't this study just look at healthy men?  These male subjects were all free of disease when the study launched in the late 1990s.  A separate analysis was conducted among more than 7,000 men with hypertension and high cholesterol in 1997, which found that the risk reduction of each healthy behavior was similar to that of men without either condition.

    Bottom line:   Unlike your genetic makeup, diet, exercise and whether or not you smoke are all within your control; in science jargon, "modifiable lifestyle factors".  Such changes may not always be easy to implement, but it can be inspiring to discover that what you do each day can play a greater role in determining your chances of a first heart attack than what you inherit

    In this large study, 86% of first heart attacks were avoided by the small proportion of men who adhered to all 5 healthy habits, regardless of family history of cardiovascular disease.  Generalized to the greater population, that means 4 out of 5 first heart attacks might be prevented with straightforward and manageable lifestyle changes.

    Get motivated to build healthy habits:

    Sources:

    Agneta Åkesson, Susanna C. Larsson, Andrea Discacciati, Alicja Wolk. "Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study." Journal of the American College of Cardiology Volume 64, Issue 13, Pages A1-A24, 1299-1306 (30 September 2014)

    Mozaffarian, Dariush. "The Promise of Lifestyle for Cardiovascular Health." Journal of the American College of Cardiology Volume 64, Issue 13, 1307-1309 (30 September 2014)

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