Influence of Lifestyle on Heart Disease Risk

Coronary heart disease (CHD) and stroke account for approximately one-third of all deaths in the United States. About 90% of patients with these conditions have at least one of the four major risk factors for heart disease and stroke—high cholesterol levels, hypertension, smoking, and diabetes mellitus. Motivating people to adopt a heart-healthy lifestyle (regular exercise and diet to maintain optimal cholesterol levels, blood pressure, and body weight) is key to CHD and stroke prevention.

In the Turkish Heart Study, our ongoing epidemiological study of CHD risk factors, we have observed a lifestyle-induced change in the most prevalent heart disease risk factor of Turks: low levels of high density lipoprotein cholesterol (HDL-C). Ten years ago, 75% of Turkish men and 50% of women had HDL-C levels <40 mg/dl, and the average levels (36 mg/dl in men and 42 mg/dl in women) were 10–15 mg/dl lower than those in Americans. The effect on CHD risk, which increases by 2–4% for every 1-mg/dl decrease in HDL-C levels, is substantial.

Between our 1990–1993 and 2003 surveys of Turks living in Istanbul, we found that HDL-C levels increased in women only, and in 2003 but not 1990–1993, there was a significant association of education and socioeconomic status with higher HDL-C levels. University-educated women had higher average HDL-C levels than those with only a primary school education (56 ± 9 versus 48 ± 12 mg/dl). The higher levels were significantly associated with lower weight (body mass index of 25.6 ± 49 versus 29.7 ± 5.1 kg/m 2 ), less cigarette smoking, and more exercise. In men, however, HDL-C levels were only slightly (~2 mg/dl) modulated by exercise, smoking, or education. The gender-related difference in the response of HDL-C to these lifestyle factors remains to be explained, but great potential exists for reducing the CHD risk of Turkish women by increasing education and socioeconomic status. As much as a 20–30% reduction in CHD risk might be expected in association with the 8 mg/dl difference in HDL-C levels of more highly educated Turkish women.

Selected References

Bersot TP, Pépin GM, Mahley RW (2003) Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol. Am. Heart J. 146:1052–1060.

Mahley RW, Arslan P, Pekcan G, Pépin GM, Agaçdiken A, Karaagaoglu N, Rakicioglu N, Nursal B, Dayanikli P, Palaoglu KE, Bersot TP (2001) Plasma lipids in Turkish children: Impact of puberty, socioeconomic status, and nutrition on plasma cholesterol and HDL. J. Lipid Res. 42:1996–2006.

Wyszynski DF, Waterworth DM, Barter PJ, Cohen J, Kesäniemi YA, Mahley RW, McPherson R, Waeber G, Bersot TP, Sharma SS, Nolan V, Middleton LT, Sundseth SS, Farrer LA, Mooser V, Grundy SM (2005) Relation between atherogenic dyslipidemia and the Adult Treatment Program-III definition of metabolic syndrome (Genetic Epidemiology of Metabolic Syndrome Project). Am. J. Cardiol. 95:194–198

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