Lower coronary heart disease deaths by making several lifestyle changes

Lifestyle modification programs that addressed at least two health behaviors lowered the risk of a fatal heart attack or stroke in people with coronary heart disease, finds a new systematic review in the American Journal of Preventive Medicine.

In a meta-analysis of nine studies, with population sample sizes ranging from 57 to 1,621 patients, the researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle programs while receiving standard care versus people who received standard care alone.

"When you look at healthy lifestyles, you should be comprehensive in doing it because it is not enough to quit smoking if you have very bad dietary habits. So, the combination of lifestyle interventions could be more beneficial," said lead author Chiara de Waure, M.D., M.Sc., an assistant professor at the Institute of Public Health at the Catholic University of Sacred Heart in Rome, Italy.

Studies varied in program duration with follow-up periods from one to nineteen years. All of the lifestyle intervention programs included diet and nutrition advice and exercise advice or sessions. A number of the studies also provided smoking cessation advice or programs, while other studies also included stress management.

"These interventions that the authors discuss may also subsequently reduce the risk of cancer, respiratory disease, and diabetes, among other chronic diseases…If anything, they were likely to underestimate the potential benefit of lifestyle change in terms of chronic disease," commented Barry Franklin, Ph.D., professor of physiology at Wayne State University School of Medicine and director of the cardiac rehabilitation program and exercise laboratories at William Beaumont Hospital in Royal Oak, Michigan.

Franklin added, "The study reiterates that the first line of defense for heart disease, that is, the most proximal risk factors, involves addressing poor diet, physical inactivity and cigarette smoking."

The review finds that lifestyle interventions are effective even in patients with established coronary heart disease, whether they had symptoms or not, and may lower the risk of non-fatal heart attack and stroke and hospital readmission.

"Sometimes when a patient develops a disease, he may think that his world is over, that there is no way to improve through lifestyles because he has already had the event, but we are showing that healthy lifestyles continue to be important even after the onset of disease," said de Waure.