title: Healthy lifestyle in the primordial prevention of cardiovascular disease among young women.
abstract: BACKGROUND
  Overall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown.
  
  
  OBJECTIVE
  The aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle.
  
  
  METHODS
  A prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses' Health Study II who were followed from 1991 to 2011. Lifestyle factors were updated repeatedly by questionnaire. A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index-2010, and 0.1 to 14.9 g/day of alcohol. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent.
  
  
  RESULTS
  During 20 years of follow-up, we documented 456 incident CHD cases. In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22). Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle.
  
  
  CONCLUSIONS
  Primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana. Electronic address: achomist@indiana.edu.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Chomistek
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D015999:Multivariate Analysis; D011322:Primary Prevention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: coronary disease; diabetes; epidemiology; hypercholesterolemia; hypertension; risk factors