Adherence to a Low-Risk, Healthy Lifestyle and Risk of Sudden Cardiac Death Among Women

Center for Arrhythmia Prevention, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 07/2011; 306(1):62-9. DOI: 10.1001/jama.2011.907
Source: PubMed


Sudden cardiac death (SCD) accounts for more than half of all cardiac deaths; the majority of SCD events occur as the first manifestation of heart disease, especially among women. Primary preventive strategies are needed to reduce SCD incidence.
To estimate the degree to which adherence to a healthy lifestyle may lower the risk of SCD among women.
A prospective cohort study of 81,722 US women in the Nurses' Health Study from June 1984 to June 2010. Lifestyle factors were assessed via questionnaires every 2 to 4 years. A low-risk lifestyle was defined as not smoking, body mass index of less than 25, exercise duration of 30 minutes/day or longer, and top 40% of the alternate Mediterranean diet score, which emphasizes high intake of vegetables, fruits, nuts, legumes, whole grains, and fish and moderate intake of alcohol.
Sudden cardiac death (defined as death occurring within 1 hour after symptom onset without evidence of circulatory collapse).
There were 321 cases of SCD during 26 years of follow-up. Women were a mean age of 72 years at the time of the SCD event. All 4 low-risk lifestyle factors were significantly and independently associated with a lower risk of SCD. The absolute risks of SCD were 22 cases/100,000 person-years among women with 0 low-risk factors, 17 cases/100,000 person-years with 1 low-risk factor, 18 cases/100,000 person-years with 2 low-risk factors, 13 cases/100,000 person-years with 3 low-risk factors, and 16 cases/100,000 person-years with 4 low-risk factors. Compared with women with 0 low-risk factors, the multivariable relative risk of SCD was 0.54 (95% confidence interval [CI], 0.34-0.86) for women with 1 low-risk factor, 0.41 (95% CI, 0.25-0.65) for 2 low-risk factors, 0.33 (95% CI, 0.20-0.54) for 3 low-risk factors, and 0.08 (95% CI, 0.03-0.23) for 4 low-risk factors. The proportion of SCD attributable to smoking, inactivity, overweight, and poor diet was 81% (95% CI, 52%-93%). Among women without clinically diagnosed coronary heart disease, the percentage of population attributable risk was 79% (95% CI, 40%-93%).
Adherence to a low-risk lifestyle is associated with a low risk of SCD.

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    • "At autopsy, the MB was identified on the LAD at 4 cm from its origin, and measured 12 mm in length and 2 mm in depth. Even if clinically significant benign bridges have been reported, it must be kept in mind that overweight and physical exercise are independent risk factors for sudden cardiac death [9] and that markers of inflammation represent important risk predictors of cardiovascular events in women [10]. Therefore, it really is not easy to know the exact etiopathogenic role of MB but, on the other hand, it is not possible to ignore its presence and its potential association with sudden cardiac death. "

    International journal of cardiology 01/2014; 172(3). DOI:10.1016/j.ijcard.2013.12.286 · 4.04 Impact Factor
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    • "These factors generally include: being physically active or physically fit, having a healthy diet, being a non-smoker, having a low waist/hip ratio or normal body mass index (BMI), and moderate alcohol consumption. US studies have shown impressive associations between self-reported adherence to healthy lifestyle factors and risk for developing hypertension as well as risk for sudden cardiac death in women [5] [6], and risk for heart failure in men [4]. In addition, a healthy lifestyle was shown to be associated with a 77% lower relative risk for myocardial infarction (MI) in postmenopausal women [1], and similar results have been reported in men [2] [7]. "
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    ABSTRACT: Objectives: A healthy lifestyle has an impact on cardiovascular health. Yet, the importance of body mass index (BMI) and gender remains less clear. The aim of this study was to investigate whether healthy lifestyle factors can predict incident cardiovascular disease (CVD) and all-cause mortality. Methods: Representative population-based prospective cohort study of 60-year-old women (n=2193) and men (n=2039). The following factors related to a healthy lifestyle were assessed using a questionnaire: non-smoking, alcohol intake of 0.6-30 g/day, moderate physical activity at least once a week, low intake of processed meats, weekly intake of fish, daily intake of fruit, and daily intake of vegetables. These factors were combined to produce a total score of healthy lifestyle factors (0-7) and classified into four groups: unhealthy (0-2 lifestyle factors), intermediate (3), healthy (4-5), and very healthy (6-7). National registers enabled identification of incident CVD (n=375) and all-cause mortality (n=427) over a follow-up of 11 years. Results: Very healthy women and men exhibited a decreased risk for incident CVD compared with unhealthy individuals, with hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for educational level and BMI of 0.44 (0.26-0.75) and 0.39 (0.25-0.61), respectively. The corresponding HRs (95% CIs) for all-cause mortality for very healthy women and men were 0.25 (0.15-0.44) and 0.35 (0.23-0.54), respectively. Conclusion: With seven healthy lifestyle factors, it was possible to identify men and women with substantially lower relative risks of incident CVD and death, regardless of BMI and educational level.
    International journal of cardiology 11/2012; 168(2). DOI:10.1016/j.ijcard.2012.10.045 · 4.04 Impact Factor
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    • "Historical analyses suggest that the environmental pressures of infectious disease and resource availability have caused women to live longer [39]. Some research suggests that lower mortality among women could be attributable to a low-risk, healthy lifestyle [40, 41], or to lack of male hormones such as testosterone [42]. Other factors include the unequal distribution of chronic conditions, health behaviors like smoking, and differential effects of diseases on mortality [40]. "
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    ABSTRACT: . Successful aging has many dimensions, which may manifest differently in men and women at different ages. Methods . We characterized one-year transitions among health states in 12 measures of successful aging among adults in the Cardiovascular Health Study. The measures included self-rated health, ADLs, IADLs, depression, cognition, timed walk, number of days spent in bed, number of blocks walked, extremity strength, recent hospitalizations, feelings about life as a whole, and life satisfaction. We dichotomized variables into “healthy” or “sick,” states, and estimated the prevalence of the healthy state and the probability of transitioning from one state to another, or dying, during yearly intervals. We compared men and women and three age groups (65–74, 75–84, and 85–94). Findings . Measures of successful aging showed similar results by gender. Most participants remained healthy even into advanced ages, although health declined for all measures. Recuperation, although less common with age, still occurred frequently. Men had a higher death rate than women regardless of health status, and were also more likely to remain in the healthy state. Discussion. The results suggest a qualitatively different experience of successful aging between men and women. Men did not simply “age faster” than women.
    Journal of aging research 10/2012; 2012(4):243263. DOI:10.1155/2012/243263
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