Preventing 86% of Heart Attacks with Diet and Lifestyle

By Marcus M. Reidenberg, MD, FACP

There has been so much written about lifestyle, diet, and heart attacks that another note seems excessive. But a recent study was so compelling that it needs to be described (1): A study of 20,721 healthy Swedish men, aged 45-79, was started in 1997 and ended in 2009. Questionnaires were used to assess 5 modifiable lifestyle factors that affect risk of a heart attack. They are: diet, smoking, alcohol consumption, physical activity, and abdominal fat.  Subjects in the best lifestyle group ate a very healthy diet (fruits and vegetables, etc.) consumed moderate alcohol (10-30 grams or 1/3 to 1 oz. of alcohol in any beverage daily), did not smoke, exercised (40 minutes walking or bicycling daily), and had a waist circumference of <95 cm (38 in). Individuals in the lowest risk group, that is, those people who met each of the above 5 criteria, had a heart attack rate of only 14% of that of the highest risk group, which consisted of those who met none of the low-risk criteria. People who met several of the criteria had an in-between risk of having a heart attack during the 12 year follow up. 

This study is in full agreement with earlier work on the burden of diseases in the United States. A report published in 2010 (2) found that unhealthy diet was the most important risk factor (and cause) of cardiovascular disease in the United States. Next in importance was smoking. Then came untreated high blood pressure, followed, in order, by low physical activity and obesity. These were the same risk factors identified in the Swedish study.

The important take-away message from these studies is that each of these risk factors can be lowered by changing behavior, and this will lower one’s chances of having a heart attack. 

One can eat more a healthy diet than we customarily do. The American Heart Association recommends a dietary pattern that emphasizes:

More details are on its web site:

and the web site of the National Institutes of Health:

The issue of moderate alcohol consumption can trouble people. But many studies have found that a small amount of alcohol consumed nearly every day lowers heart attack risk. This was originally called the “French paradox”; the French traditional diet was what we would call heart unhealthy, but the French had lower heart attack rates than expected. The conclusion was that the lower heart attack rate was related to the modest amount of alcohol consumed--often wine with meals every day--by most French adults.

Not smoking is best, but any decrease is better than keeping up the present habit if one smokes. Not smoking lowers the risk of lung and other cancers as well as heart attacks. Not smoking is one of the most healthful things one can do.

Vigorous exercise is promoted widely, but this study shows that moderate exercise also makes a significant difference in heart attack rate.

The waist circumference is a measure of obesity, and obesity is very unhealthful. Abdominal fat seems more unhealthful that fat on the shoulders or arms and legs and appears to be metabolically different. This is why waist circumference rather than weight or body mass index seems to be the best measure of obesity-related health risk.

For healthy longevity, hypertension and any other chronic diseases should be treated and controlled.

To reiterate, adopting the healthy lifestyle in line with the factors discussed above can make a huge difference in the risk of a heart attack.


  1. Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men. J Amer col Cardiol2014; 64: 1299-1306
  2. US Burden of Disease Collaborators. The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors. JAMA 2013; 310: 591-608.

Posted 12/16/2014

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