Prevention of coronary heart disease in women

Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle

Summary

Despite the drastic declines in coronary heart diseases, it remains the number one cause of death worldwide. About the establishment of coronary heart diseases, a lot is already known. However, research is mostly done in men. Even though, studies show that heart diseases are also an important cause of death in women. Furthermore, it is clear that women show atypical symptoms of coronary disease, these atypical symptoms can cause a delay in the recognition of a heart disease. As heart diseases are one of the main killers, prevention methods should be implemented to improve the overall health of the population. This study assesses the effect of a combination of lifestyle practices on the risk of coronary heart disease in women. The study determines the proportion of coronary events that could potentially be prevented by following a set of dietary and behavioural guidelines. The study also evaluated the effects of the practices on the risk of stroke.

How is the research carried out?

The population consists of female nurses from ‘The Nurses’ Health Study’, which was established in 1976. The nurses from age 30 to 55 years provided detailed information by questionnaire and every two years, a follow-up questionnaire was sent to update the information on potential risk factors and to identify newly diagnosed cases of various diseases.

What does the research tell us?

Woman which were classified in the group of low risk factors (which only made up 3% of the population) had a 5.8 times lower risk of coronary events compared to all the other women. The low risk factor group consisted of women who had stopped smoking or never smoked, who had moderate alcohol consumption, who engaged in physical activity for at least one-half-hour per day of vigorous or moderate activity, who had a BMI (body-mass index) less that 25 and who followed a diet low in trans fat and glycaemic load, high in cereal fibre, high in marine n-3 fatty acids and folate and a high ratio of poly-unsaturated to saturated fat. 82 % of the coronary events in the study group, could be contributed to lack of adherence to this low-risk pattern.

What is to be done?

Among women, adherence to lifestyle guidelines involving diet, exercise and abstinence from smoking is associated with a very low risk of coronary heart disease. However, a big part of the population does not follow these guidelines. Primary prevention should focus on life style factors (smoking, diet, physical activity) on the total population to reduce the incidence of coronary diseases.

Source: N Engl J Med 2000; 343:16-22

Lifestyle intervention in diabetes

Intensive Lifestyle Intervention in Type 2 Diabetes

Summary

Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. This study examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients.

In 16 study centers in the United States, researchers randomly assigned approximately 5000 obese patients with type 2 diabetes to participate in an intensive lifestyle program that promoted weight loss through decreased caloric intake and increased physical activity 1 or to receive diabetes support and education 2. The researchers then followed both groups over a period of maximum 13.5 years to see how they compared on number of deaths from cardiovascular causes, nonfatal myocardial infarction 3, nonfatal stroke or hospitalization for pain.

Naturally, weight loss was greater in the intervention group than in the control group throughout the study. The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin 4 and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels.

What do we want to know?

Would an intensive lifestyle intervention designed to achieve weight loss through caloric restriction and increased physical activity decrease cardiovascular morbidity and mortality among overweight or obese adults with type 2 diabetes?

What is the research about?

Researchers took overweight or obese adults with diabetes type 2 and researched whether those people have a decreased cardiovascular morbidity and mortality if they undergo an intensive lifestyle intervention( to achieve weight loss through caloric restriction and increased physical activity.

What does the article tell us and what does this mean?

The study was published in 2013 and showed that an intensive lifestyle intervention did not reduce the risk of cardiovascular morbidity or mortality, as compared with a control program of diabetes support and education, among overweight or obese patients with type 2 diabetes.

 

Source: N Engl J Med 2013; 369:145-154