Abstract MP85: Lifestyle and Biologic Factors and Risk for Recurrent Coronary Heart Disease Events

Abstract

The 2011 American Heart Association guidelines recommend lifestyle modification and risk factor management for secondary coronary heart disease (CHD) prevention. We determined the association of lifestyle behaviors and clinical management risk factors with recurrent CHD events among participants with electrocardiographic evidence or self-reported CHD history from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239). Ideal health factors (normal waist circumference, physical activity ≥4 times/week, DASH diet adherence, not smoking, systolic/diastolic blood pressure (BP) < 120 / 80 mmHg and LDL-cholesterol (LDL-C) < 70 mg/dL) were assessed through questionnaires and an in home study visit. Of the 4,174 REGARDS participants with CHD history, the mean age was 68.8 (SD=8.9) years, 35.1% were women and 34.1% were black. Over a median follow up of 4.3 (maximum=6.9) years, 447 (10.7%) participants had a nonfatal or fatal recurrent CHD event. After adjustment for demographics, clinical factors, and co-morbid conditions, participating in physical activity ≥4 times/week versus no activity and not smoking versus current smoking were associated with a reduced risk for recurrent CHD events (hazard ratio [95% confidence interval] 0.48 (0.34-0.68) and 0.45 (0.35-0.56), respectively). In contrast, DASH diet consistency, normal waist circumference, LDL-C and normal BP were not associated with statistically significant reductions in risk for recurrent CHD events. More ideal health factors were associated with a lower risk for recurrent CHD events (Figure). The hazard ratio for each additional ideal health factor was 0.76 (95% CI: 0.69-0.84). If these observations are causal, then if all people with established CHD participated in physical activity 4+ times/week and did not smoke, 40.5% (95% CI: 11.0-63.4) of recurrent CHD events could be avoided. This analysis suggests that secondary prevention to lower the risk of recurrent CHD events should emphasize physical activity and smoking cessation.