Healthy Lifestyle Overview

• Cardiovascular health in middle age and beyond is more affected by a healthy lifestyle in young adulthood than genetics. The top five healthy behaviors are weight control, physical activity, a healthy diet, low or no alcohol intake, and not-smoking.

• Four lifestyle factors contribute to the lion’s share of global burden of disease and disability as shown below

• The prevalence of a low-risk profile was 60% for participants who followed all five healthy lifestyle factors, 37% for four factors, 30% for three factors, 17% for two, and 6% for one or zero. (AHA abstract 2010). However alcohol is a double edged sword and harm from excessive use of alcohol often outweigh the benefits from healthy use of it.

• According to a new study from Australia, about AU$ 9 billion could have been saved in 2008 if smoking, high-alcohol consumption, high body mass index (BMI), physical inactivity, inadequate fruit and vegetable intake (less than 3 servings per day) and intimate partner violence were eliminated from the Australian population,.  Eradicating these six behavioral risk factors would dramatically decrease the incidence of preventable diseases, such as stroke, diabetes, and cardiovascular disease, and would reduce the country’s medical expenses and increase work productivity.¹

• Five million days of work productivity could be added each year due to decreased absenteeism, 161,000 new cases of disease prevented, and 6000 premature deaths averted if reduction of these risk factors is achieved.¹

• There is robust evidence that lifestyle modification has a sustained effect on reducing incidence of diabetes,^2-5 and helps reduce the occurrence and mortality of cardiovascular disease (CVD) events in people with and without established  coronary artery disease (CAD).⁶

• In the general population the risk  of death is reduced by 50 % in those who stop smoking, 20 – 30 % by engaging in moderate physical activity, and 15-40 % by adopting a combination of healthy dietary habits (limited intake of saturated fats, regular fish consumption, sufficient fruit and vegetable intake, and limited salt consumption).⁷

• The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.⁸ Those with all 4 poor health behaviors compared with those with none had an all-cause mortality risk equivalent to being 12 years older. ⁸ Individuals who exhibited all 4 poor health behaviors had about 3 times the risk of CVD and cancer mortality and 4 times the risk of dying from other causes compared with those exhibiting none of the above behaviors.⁸

• Improving diet and lifestyle is a critical component of preventing CVD. If we want our lives to be healthy and fruitful, we need to follow some key steps to avoid heart disease. The most recent recommendation of the American Heart Association (AHA) emphasizes the following elements as given in Table 117 A⁹

• Do not smoke. No amount of smoking is safe. Tobacco smoke contains more than a few thousand chemicals including nicotine which can damage your heart by increasing blood pressure and making it work harder. Quitting smoking dramatically reduces your risk of heart disease within just one year.

• Take regular walks. Walking is a panacea for heart diseases. Physical activities help you to control your weight and reduce blood pressure, cholesterol level and diabetes. It is recommended that you do at least 30 to 60 minutes of physical activity daily like walking briskly, swimming, cycling and so forth.

• Eat a healthy diet and maintain a healthy weight. Fruits, vegetables, whole grain legumes and fish are heart-friendly foods. Alcohol intake in moderation is also regarded as beneficial but not among Indians possibly due to unhealthy pattern of drinking.

Table 117 A- AHA Recommendations for Healthy Lifestyle

Avoid all kinds of tobacco Consume a healthy diet: focus on overall diet rather than a single component.

Maintain a healthy body weight with BMI 18.5-24.9kg/m2. (18.5-22.9kg/m2  for Indians).

Aim for optimal lipid profile with LDL less than 100mg/dl (The principal determinant of LDL are saturated fat and trans fat).

Aim for a normal blood pressure <120/80. Dietary factors that impact blood pressure include salt, moderate alcohol intake, and maintaining optimal weight

Aim for normal blood glucose, less than or equal to 100mg/dL.

Be physically active: exercise at least 30 minutes most days of the week.        Balance exercise with caloric intake.

Specific dietary recommendations include: Eat a variety of fruits and vegetables. Choose whole grain, high fiber products. Consume fish at least twice a week. Limit saturated fat to less than 7% of energy, trans fat to less than 1% energy; and cholesterol to less than 200mg/day.

Total fat should equal 25-35% of calories. Limit salt to 1.5-2.3g/day.

Drink alcohol in moderation: 2 drinks/day for men; 1 drink/day for women.

Follow AHA recommendations when eating away from home.

•  Foods to be avoided are processed red meat, butter, cheese, excessive milk products, coconut oil (also coconut meat and milk), fried fast foods and packaged snacks.

• Excessive weight increases you chances of heart disease. In general, a waist measurement greater than 35 inches (90cm) for men and 32(80cm) inches for women is considered to be a sign of being overweight among Indians. A simple rule of thumb is that your waist circumference should be 50% or less than your height, regardless of age, gender or ethnicity.

• It is a well accepted fact that intervention is expensive and prevention is cost effective. Adopting a healthy-heart lifestyle is not a complicated procedure. It doesn’t mean you have to live a life of self-deprivation or compromise your standard of living. You should find ways to incorporate healthy-heart habits into your lifestyle, and you will enjoy a healthier life for years to come.
• Community-based programs to increase physical activity,  improve nutrition and prevent smoking can provide a return on investment of $5.60 for every dollar spent within 5 years in the US.

1. Cadilhac DA, Magnus A, Sheppard L, Cumming TB, Pearce DC, Carter R. The societal benefits of reducing six behavioural risk factors: an economic modelling study from Australia. BMC Public Health. Jun 21 2011;11(1):483.

2. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.

3. Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. Nov 14 2009;374(9702):1677-1686.

4. Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. May 24 2008;371(9626):1783-1789.

5. Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. Nov 11 2006;368(9548):1673-1679.

6. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. Jun 10 2008;117(23):3031-3038.

7. Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC, van Staveren WA. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation. Aug 9 2005;112(6):924-934.

8. Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR. Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med. Apr 26 2010;170(8):711-718.

9. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. Jul 4 2006;114(1):82-96.