Stress is a part of life for just about everyone. Sometimes it is not easy to recognize stress because we are caught up in the flow of life. Although stress happens first in the mind, it has strong effects on the body.
People who have high levels of stress or prolonged stress have higher cholesterol or blood pressure. They may be more prone to narrowing of the arteries atherosclerosis , a stroke risk factor. Learn more about how to manage stress. If you have a recent heart disease diagnosis, you might find information on emotions and feelings helpful.
Learn about other risk factors for heart disease. Learn how to live a healthier lifestyle. Take control and face the challenge of lifestyle changes. Talking to your doctor.
Make a plan for healthy changes. Donate now. Unhealthy diet The foods you eat affect your health. A detailed description of the included foods in the respective food groups and serving sizes used for assessing adherence is found in Additional file 1: Table S1. Population subgroups were classified based on the following non-modifiable risk factors: age, gender, educational level, and parental history of MI.
The participants were divided into three age groups: Information on educational level and parental history of MI was extracted from the baseline questionnaire.
Elementary degree was defined as a high-risk group. We examined baseline characteristics across categories of lifestyle score favorable, intermediate, unfavorable. Continuous variables across lifestyle categories are expressed as mean values with standard deviation and differences were tested using ANOVA.
Skewed continuous variables are expressed as median with interquartile range and differences were tested using Kruskal-Wallis ranksum test. Baseline characteristics were further examined for each of the population risk groups: age, gender, educational level, and parental history of MI. Cox proportional hazards regression models were used to model the association between the lifestyle score and incident CAD overall and stratified by non-modifiable risk factors.
The proportional hazards assumption was tested using the Schoenfeld residuals; no deviation was noted. The cumulative risk standardized year coronary event rate based on a Cox regression model by lifestyle categories was further estimated within strata of non-modifiable risk factors. A favorable lifestyle was associated with a better risk profile in relation to known CAD risk factors Table 1.
Participants with a favorable lifestyle had a lower likelihood of hypertension and favorable blood-lipid levels as well as being less likely to have diabetes at baseline.
Baseline characteristics across the population risk groups age, gender, educational level, and parental history of MI are shown in Additional file 1 : Table S2-S5. The CAD event rates over study follow-up across categories of lifestyle risk and different population risk groups are shown in Additional file 1 : Fig.
Participants with an unfavorable lifestyle had a higher risk of CAD than those with a favorable lifestyle with a HR of 1. Similarly, the adjusted event rate was higher among all high-risk groups compared to low-risk groups Additional file 1 : Fig. Across all strata of non-modifiable risk factors, adherence to a favorable lifestyle was associated with a lower risk of CAD Fig.
Unfavorable lifestyle and high-risk categories were used as reference categories denoted ref. Models were adjusted for sex, age, educational level and parental history of MI. For participants at high age the standardized year coronary event rate was A similar pattern was noted in the other high risk groups where a favorable lifestyle lowered the absolute risk in these groups compared to an unfavorable lifestyle.
For men with an unfavorable lifestyle the year coronary event rate was The group with elementary education and an unfavorable lifestyle had a cumulative risk of 6. For participants with a history of MI, an unfavorable lifestyle was associated with a 7. In this study, we examined the putative effect of a favorable lifestyle across strata of established non-modifiable risk factors. Overall, we found that a favorable or intermediate lifestyle compared to an unfavorable lifestyle was associated with a significantly lowered risk of CAD regardless of the population subgroup.
A meta-analysis including 22 studies examining the association between a combination of different lifestyle risk factors on risk of CVD was recently published [ 20 ].
While operationalized lifestyle scores differ, there was a consistent inverse association between a healthy lifestyle and CVD risk with a summary HR estimate of 0. The results of the current study are thus in line with several previous studies [ 20 ]. A Swedish cohort study examined the impact of healthy lifestyle in a population with high-risk of stroke. Another cohort study of year-old men and women found that adherence to healthy lifestyle factors reduced the relative risk of CVD incidence and death, regardless of BMI and educational level [ 22 ].
Similarly, a population-based prospective cohort study in Sweden, examined the effect of five lifestyle factors healthy diet, moderate alcohol consumption, physical activity, no smoking and no abdominal adiposity on the incidence of MI in men [ 23 ]. Gooding et al. This study showed that a high adherence to the AHA recommendations associated with lower likelihood of progressing to poor cardiovascular health, suggesting benefit of early implementation of favorable lifestyles [ 25 ].
Within the Atherosclerosis Risk in Communities ARIC study, the benefit of physical activity was previously shown to be independent of family history of premature coronary heart disease [ 26 ]. This finding is also in line with the results of this study, showing that also an overall favorable lifestyle including physical activity lowers the risk of CAD regardless of parental history of MI. Studies have shown that lifestyle counseling in the primary care for patients at high risk results in favorable lifestyle changes and lowers the risk of CAD [ 27 , 28 , 29 ].
Overall, our findings therefore reinforce that adherence to a favorable lifestyle is of considerable importance in the prevention of CAD [ 30 ], regardless of underlying baseline risk.
In addition, this study is strengthened by the availability of extensive data from baseline examinations including dietary data of high relative validity [ 15 , 31 ]. Our study has several limitations that should be discussed. Participants in the study joined spontaneously or were recruited mainly through invitations.
However, a previous study has shown that the socio-demographic structure, prevalence of smoking habits and obesity were similar compared to another survey in the same population [ 32 ]. Another limitation of this study is that diet and lifestyle were self-reported and all risk factors were assessed at baseline only. Both self-reported data and data based on assessment at a single point in time will be subject to measurement error.
However, due to the prospective study design any exposure misclassification would most likely result in an attenuation of observed associations. Since this is an observational study there is always a possibility of residual confounding and there are several other putative factors contributing to the development of CVD, apart from the traditional risk factors considered in this study.
Finally, the lifestyle score used in this study dichotomizes lifestyle exposures for simplicity in interpretation and assessment of adherence to current recommendations. The associations between the included lifestyle factors and risk of CAD are however likely to be continuous. Hence, the effect of the included individual lifestyle factors may be attenuated because of including subjects who may still derive a benefit at levels below our cut-points.
Further, for assessment of lifestyle risk each lifestyle component contributed similarly to the overall score and no relative weighting of the individual components was performed. These findings support the usefulness of lifestyle-targeted CAD prevention among subgroups at higher non-modifiable risk within the overall healthy population. The dataset analyzed is not publicly available due to restriction in the ethical permission.
All codes and syntaxes used for analysis are available from the corresponding author upon reasonable request. Healthy lifestyle factors associated with reduced cardiometabolic risk. Br J Nutr. The health risks of smoking. The Framingham study: 34 years of follow-up.
Ann Epidemiol. What do review papers conclude about food and dietary patterns? Food Nutr Res ; Article Google Scholar. Regular physical activity and cardiovascular biomarkers in prevention of atherosclerosis in men: a year prospective cohort study.
BMC Cardiovasc Disord. Obesity as an independent risk factor for cardiovascular disease: a year follow-up of participants in the Framingham heart study. Dhingra R, Vasan RS. High blood cholesterol usually has no signs or symptoms. The only way to know whether you have high cholesterol is to get your cholesterol checked. Learn more about getting your cholesterol checked. Diabetes mellitus. Your body needs glucose sugar for energy. Diabetes causes sugar to build up in the blood.
The risk of death from heart disease for adults with diabetes is higher than for adults who do not have diabetes. Obesity is excess body fat. Obesity can lead to high blood pressure and diabetes as well as heart disease. Talk with your health care team about a plan to reduce your weight to a healthy level.
Learn more about healthy weight. When members of a family pass traits from one generation to another through genes, that process is called heredity. Genetic factors likely play some role in high blood pressure, heart disease, and other related conditions.
However, it is also likely that people with a family history of heart disease share common environments and other factors that may increase their risk. The risk for heart disease can increase even more when heredity combines with unhealthy lifestyle choices, such as smoking cigarettes and eating an unhealthy diet. Heart disease is the number one killer of both men and women. Heart disease can happen at any age, but the risk goes up as you age.
Heart disease and stroke can affect anyone, but some groups are more likely to have conditions that increase their risk for cardiovascular disease. Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans, American Indians and Alaska Natives, and white people. Skip directly to site content Skip directly to page options Skip directly to A-Z link.
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