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Healthy diet and lifestyle behaviors associated with decreased risk of heart attack in women

The JAMA Network Journals

Women who eat a healthy diet, drink moderate amounts of alcohol, are physically active, maintain a healthy weight and do not smoke have a significantly reduced risk of heart attack, according to a report in the October 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Coronary heart disease is the most important cause of death and disability in women," the authors write as background information in the article. "Despite a lower incidence in women, coronary heart disease-related mortality and the percentage of sudden deaths from coronary heart disease without previous symptoms is higher and the trend of decline in incidence is slower than in men."

Agneta Akesson, Ph.D., M.P.H., of the Karolinska Institutet, Stockholm, and colleagues identified dietary patterns in 24,444 postmenopausal women by analyzing food frequency questionnaires, on which the women supplied information about how often they ate 96 common foods. "We derived four major dietary patterns: 'healthy' (vegetables, fruits and legumes), 'Western/Swedish' (red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes and fish), 'alcohol' (wine, liquor, beer and some snacks) and 'sweets' (sweet baked goods, candy, chocolate, jam and ice cream)," the authors write. Participants also answered questions about education, family history, health status, use of medications, body measurements and physical activity. When they enrolled in the study in 1997, none of the women had heart disease, diabetes or cancer.

Over an average of 6.2 years of follow-up, 308 women had a new myocardial infarction (heart attack); 51 of these cases were fatal. Two diet types--"healthy" and "alcohol"--were associated with a reduced risk for heart attack.

"The low-risk diet (high scores for the healthy dietary pattern) characterized by a high intake of vegetables, fruit, whole grains, fish and legumes, in combination with moderate alcohol consumption (5 grams of alcohol per day or less), along with the three low-risk lifestyle behaviors [not smoking, having a waist-hip ratio of less than the 75th percentile and being physically active], was associated with 92 percent decreased risk compared with findings in women without any low-risk diet and lifestyle factors," the authors write. "This combination of healthy behaviors, present in 5 percent, may prevent 77 percent of myocardial infarctions in the study population."

Several components of fruits, vegetables and whole grains--including fiber, antioxidant vitamins and minerals--have been associated with a reduced risk for coronary heart disease, the researchers note. In addition, previous studies have found beneficial effects of small amounts of alcohol in preventing the buildup of plaque in the arteries, which could help prevent heart attacks.

"Our study findings indicate that healthy dietary behaviors are present in the population," the authors conclude. "These dietary behaviors together with a healthy lifestyle and body weight may prevent most myocardial infarction events."

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(Arch Intern Med. 2007;167(19):2122-2127. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by research grants from the Center for Health Care Sciences, Karolinska Institutet; the Swedish Research Council/Medicine and Longitudinal Studies; and the Swedish Council for Working Life and Social Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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