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.
Saturated fat intake in Minsk (Belarus), a high-risk area for heart disease
