David Brill
The drive to promote healthy living is gathering fresh momentum, with the publication of two major new studies suggesting substantial potential to tackle cardiovascular disease at a population-wide level.
Fourteen-year follow-up of over 83,000 healthy women in the Nurses’ Health Study showed that those who ate well, exercised and had lower BMI were considerably less likely to develop hypertension – the leading preventable contributor to death in women.
The Physicians’ Health Study, meanwhile, reported that keeping healthy significantly reduced the risk of developing heart failure over 22 years in a cohort of some 21,000 men. Those who followed at least four out of six healthy habits had a 10.1 percent lifetime risk of developing heart failure, compared to 21.2 percent for men who followed none of the six.
Both Asian and international experts are calling for a renewed focus on public health promotion in light of the data.
Dr. Goh Ping Ping, medical director of the Singapore Heart Foundation and chief of cardiology at Changi General Hospital, said that a lot of work remains to be done at the community level and urged doctors to “take a very proactive role”, particularly with opportunistic screening.
“Even if a patient comes in for a medical problem that is not directly related to the heart or to hypertension, [doctors] could also take the opportunity to check their blood pressure, or educate them on these very simple lifestyle principles,” she said, adding that further educational materials should be kept on hand for such cases.
An editorial accompanying the two papers noted that the “powerful simplicity” of the message begs a rethink on the very concept of lifestyle, which is often perceived to be an individual choice. Rather, it is an interaction between personal and societal factors that defines the approach to cardiovascular disease prevention, according to Dr. Véronique Roger of the Mayo Clinic, Minnesota, US. [JAMA 2009;302:437-439]
“The studies … underscore that healthy lifestyle will help prevent cardiovascular disease and greatly enhance health, which is a compelling reminder that health is the shared responsibility of individuals and communities. This in turn implies that public health policies and clinical care must join forces to achieve effective disease prevention,” she wrote.
The Nurses’ Health Study enrolled 83,882 women aged 27 to 44 in 1991, and followed them up until 2005. [JAMA 2009;302:401-11]
BMI, exercise, alcohol intake, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, use of non-narcotic analgesics and folic acid supplementation were all independently associated to risk of developing hypertension. Women who scored well on all six factors had a hazard ratio of just 0.22 (95% CI 0.10 – 0.51) for incident hypertension. Such healthy livers, however, comprised just 0.3 percent of the population.
The Physicians’ Health Study involved 20,900 men with a mean age of 53.6 at enrollment in 1982, with follow-up until 2008 (mean 22.4 years). [JAMA 2009;302:394-400]
Six lifestyle factors were also assessed: smoking, exercise, body weight, alcohol intake, consumption of fruits and vegetables, and consumption of breakfast cereals. Again, all factors were independently and jointly linked to an increased risk of heart failure.
Singapore’s Health Promotion Board welcomed the studies as “good evidence as to the importance of a healthy lifestyle,” given their size and robust data.
“A large proportion of chronic disease amongst the Asian population can be attributed to lifestyles, i.e. eating habits and lack of physical activity,” said Dr. Shyamala Thilagaratnam, director of the Healthy Ageing Division. “Therefore encouraging Singaporeans to lead a healthy lifestyle is likely to be useful in reducing the burden of chronic disease. Singaporean and other Southeast Asian doctors should use this as good evidence to promote the adoption of a healthy lifestyle amongst their patients.”
Goh added that it is important to adapt the messages of the studies to match local cultures and habits.
“Our dietary patterns are quite different – they talk about cereals for breakfast but that probably doesn’t apply too well here. It’s probably more about telling people not to have nasi lemak or roti prata, for example, and to substitute with something else,” she said.
Fourteen-year follow-up of over 83,000 healthy women in the Nurses’ Health Study showed that those who ate well, exercised and had lower BMI were considerably less likely to develop hypertension – the leading preventable contributor to death in women.
The Physicians’ Health Study, meanwhile, reported that keeping healthy significantly reduced the risk of developing heart failure over 22 years in a cohort of some 21,000 men. Those who followed at least four out of six healthy habits had a 10.1 percent lifetime risk of developing heart failure, compared to 21.2 percent for men who followed none of the six.
Both Asian and international experts are calling for a renewed focus on public health promotion in light of the data.
Dr. Goh Ping Ping, medical director of the Singapore Heart Foundation and chief of cardiology at Changi General Hospital, said that a lot of work remains to be done at the community level and urged doctors to “take a very proactive role”, particularly with opportunistic screening.
“Even if a patient comes in for a medical problem that is not directly related to the heart or to hypertension, [doctors] could also take the opportunity to check their blood pressure, or educate them on these very simple lifestyle principles,” she said, adding that further educational materials should be kept on hand for such cases.
An editorial accompanying the two papers noted that the “powerful simplicity” of the message begs a rethink on the very concept of lifestyle, which is often perceived to be an individual choice. Rather, it is an interaction between personal and societal factors that defines the approach to cardiovascular disease prevention, according to Dr. Véronique Roger of the Mayo Clinic, Minnesota, US. [JAMA 2009;302:437-439]
“The studies … underscore that healthy lifestyle will help prevent cardiovascular disease and greatly enhance health, which is a compelling reminder that health is the shared responsibility of individuals and communities. This in turn implies that public health policies and clinical care must join forces to achieve effective disease prevention,” she wrote.
The Nurses’ Health Study enrolled 83,882 women aged 27 to 44 in 1991, and followed them up until 2005. [JAMA 2009;302:401-11]
BMI, exercise, alcohol intake, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, use of non-narcotic analgesics and folic acid supplementation were all independently associated to risk of developing hypertension. Women who scored well on all six factors had a hazard ratio of just 0.22 (95% CI 0.10 – 0.51) for incident hypertension. Such healthy livers, however, comprised just 0.3 percent of the population.
The Physicians’ Health Study involved 20,900 men with a mean age of 53.6 at enrollment in 1982, with follow-up until 2008 (mean 22.4 years). [JAMA 2009;302:394-400]
Six lifestyle factors were also assessed: smoking, exercise, body weight, alcohol intake, consumption of fruits and vegetables, and consumption of breakfast cereals. Again, all factors were independently and jointly linked to an increased risk of heart failure.
Singapore’s Health Promotion Board welcomed the studies as “good evidence as to the importance of a healthy lifestyle,” given their size and robust data.
“A large proportion of chronic disease amongst the Asian population can be attributed to lifestyles, i.e. eating habits and lack of physical activity,” said Dr. Shyamala Thilagaratnam, director of the Healthy Ageing Division. “Therefore encouraging Singaporeans to lead a healthy lifestyle is likely to be useful in reducing the burden of chronic disease. Singaporean and other Southeast Asian doctors should use this as good evidence to promote the adoption of a healthy lifestyle amongst their patients.”
Goh added that it is important to adapt the messages of the studies to match local cultures and habits.
“Our dietary patterns are quite different – they talk about cereals for breakfast but that probably doesn’t apply too well here. It’s probably more about telling people not to have nasi lemak or roti prata, for example, and to substitute with something else,” she said.
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