Introduction:
Adults with a 10 year predicted atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% are candidates for statin therapy for primary prevention. Lifestyle interventions may benefit this high risk group. Hypothesis: We estimated the use of healthy lifestyles and their association with ASCVD and mortality risk in adults with a 10 year predicted ASCVD risk ≥7.5%. Methods: The REasons for Geographic and Racial Differences in Stroke cohort study enrolled adults ≥45 years old from the 48 continental US states and District of Columbia in January 2003 - October 2007 (n=30,239). The final sample was restricted to adults 45 - 79 years old, without ASCVD or diabetes history, low density lipoprotein cholesterol 70 - 189 mg/dL and a 10 year predicted ASCVD risk ≥7.5% (n=5,709). Ideal lifestyle factors, assessed during an in-home physical exam and through surveys, included non-obese waist circumference (<88/<102 cm for women/men), physical activity (PA) ≥4 times per week, nonsmoking, low saturated fat intake (<7.0% of daily calories) and highest Mediterranean diet score quartile. Participants were contacted every 6 months to detect incident ASCVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or coronary heart disease death) and all-cause mortality for adjudication. Results: The prevalence of ideal lifestyles was 56.9% for non-obesity, 33.5% for PA, 80.7% for nonsmoking, 7.1% for low saturated fat intake, and 27.6% for highest Mediterranean diet score quartile. Overall, 4.8%, 27.2%, 35.5%, 23.5% and 9.0% had 0, 1, 2, 3, and ≥4 of the 5 ideal lifestyles. There were 377 ASCVD events and 471 deaths (median follow up: 5.8 and 6.0 years, respectively). After multivariable adjustment, there was a graded association for lower ASCVD incidence and mortality with 1, 2, 3 and ≥4 versus 0 ideal lifestyles (Table 1). Conclusion: Healthy lifestyles were underused in adults with a 10 year predicted ASCVD risk ≥7.5%. Improving lifestyle factors may significantly reduce ASCVD and delay mortality in this high risk population.
Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial
