Healthy Lifestyle

Epidemiological, metabolic, and clinical studies conducted over the last few decades have identified important factors that contribute to the development of cardiovascular disease (CVD). Accordingly, several modifiable (smoking, blood pressure, lipid/lipoprotein and glucose levels, diabetes mellitus, poor diet, lack of physical activity/exercise, obesity, and psychosocial factors) and nonmodifiable (age, gender, and genetic predisposition) CVD risk factors are now recognized in contemporary clinical practice.1 The health hazards of obesity have been recognized for centuries,2 and in 1998, obesity was reported as a major modifiable risk factor for CVD by the American Heart Association.3Article p 3062 In this issue of Circulation , Jensen et al4 report an analysis of the associations of obesity (defined by body mass index [BMI]) in combination with physical activity, smoking, and a Mediterranean diet with the risk of acute coronary syndrome (ACS; defined as unstable angina pectoris and nonfatal and fatal acute myocardial infarction) in a prospective, population-based study of 54 783 middle-aged men and women. The investigators found that the association between BMI and ACS was strong and graded, and the absolute risk was substantially higher among men. Behavioral risk factors such as smoking, relative physical inactivity, low adherence to the Mediterranean diet, and having the lowest alcohol intake were all associated with a higher risk of ACS. Of importance, BMI was associated with risk of ACS at all levels of classic behavioral lifestyle risk factors: physical inactivity, smoking, and unhealthy diet. These findings suggest that obesity is important even in subjects who adhere to an otherwise healthy lifestyle.In the present study, adiposity status was assessed by BMI, and physical activity was self-reported. Although this prospective study used validated end points, one must consider that assessments of adiposity and physical activity may have introduced biases, which are probably overcome by …