Few Americans Follow All 4 Elements of a Heart-Healthy Lifestyle

A new study finds that fewer than 3% of Americans are active enough, eat a healthy diet, are nonsmokers, and have a healthy weight and percentage of body fat—the 4 important elements of a heart-healthy lifestyle that are promoted by the American Heart Association’s (AHA) Strategic Impact Goal for 2020 and Beyond. The study, published in the April 2016 issue of Mayo Clinic Proceedings, differs from previous studies that have examined these lifestyle characteristics separately, because it examines the independent and combined affects of the 4 healthy lifestyle characteristics on markers of cardiovascular disease.

Paul D. Loprinzi, MD, and colleagues used 2003 through 2006 National Health and Nutrition Examination Survey data from a sample of 4745 Americans ages 20 to 85 for 4 parameters: being sufficiently active (getting at least 150 minutes of moderate exercise per week); being a nonsmoker; eating a healthy diet (that includes enough vegetables and whole grains and avoiding saturated fats); and having a recommended body fat percentage (up to 20% for men and 30% for women).

Markers of cardiovascular health included mean blood pressure in the arteries, C-reactive protein (CRP, a sign of inflammation), total cholesterol, high-density lipoprotein cholesterol (HDL-C), the ratio of total cholesterol to HDL-C, fasting low-density lipoprotein (LDL) cholesterol, fasting triglycerides, fasting blood sugar, fasting insulin, and hemoglobin A1C, a measure of blood glucose over several months.

The study was conducted from August 15, 2013, through January 5, 2016. Diet information was self-reported but the remaining data came from results of blood tests, accelerometers (to measure physical activity) and dual-energy x-ray absorptiometry (to determine percentage of body fat).

The study found that only 2.7% of all adults had all 4 healthy lifestyle characteristics and 11.1% had none of the healthy lifestyle characteristics. A total of 71.5% of adults do not smoke, 37.9% consumed a healthy diet, 9.6% had a normal percentage of body fat, and 46.5% were sufficiently active. Compared with men, women were more likely to not smoke and eat a healthy diet and were less likely to be sufficiently active. Older adults and non-Hispanic blacks had the fewest number of healthy lifestyle characteristics.

Study participants with 3 or 4, compared with no healthy lifestyle characteristics, had more favorable levels of markers for cardiovascular disease, except for mean arterial blood pressure, fasting blood sugar, and hemoglobin A1C. Having at least one or two healthy characteristics versus no healthy lifestyle characteristics had a favorable effect on CRP, HDL-C, total cholesterol, and measures of an amino acid that is associated with a higher risk of heart attack, stroke, and blood clots.

“Although multiple healthy lifestyle characteristics are important, specific healthy lifestyle characteristics may explain much of the variation for several of the markers for heart health,” the study suggested.

More research is needed to identify strategies that work to increase the adoption of multiple healthy lifestyle characteristics among adults.