Author + information
- Bamba Gaye, PhD∗ (, )
- Luc Djousse, MD, ScD, MPH and
- Jean Philippe Empana, MD, PhD
- ↵∗INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, 56 Rue Leblanc, Paris, #75015, France
Lv et al. (1) sought to examine the association of a combination of modifiable healthy lifestyle factors with the risk of ischemic cardiovascular disease. They observed that adherence to a healthy lifestyle might substantially lower the burden of cardiovascular diseases in the Chinese, and this would prevent approximately two-thirds of major coronary events and two-fifths of ischemic strokes over a period of <10 years.
The difference between their definition of healthy lifestyle components based on cited papers (2,3) and the American Heart Association (AHA) definition (4) (referenced elsewhere in their paper) raised some concerns. For instance, the low-risk group for smoking was defined as “nonsmokers or those who had stopped smoking for reasons other than illness for ≥6 months.” The rationale for this cutpoint is not clear, especially because the Chinese population may have a high proportion of heavy smokers. The AHA defined ideal smoking status as “stopped smoking ≥12 months or never smoked.”
Lv et al. defined the low-risk group for diet as “those who eat vegetables and fruits every day.” It should be made clear that those who ate vegetables and fruits every day could include people consuming 7 servings per week, which is lower than the recommended 30 servings per week (4.5 servings per day) (4).
Taking into account these 2 definitions, we acknowledge that the investigators might be underestimating the true effect of adhering to healthy factors.
Furthermore, low-risk lifestyle appears to be a strong predictor of outcomes across populations with different cardiovascular health manifestations (i.e., Western countries vs. China).
Please note: Dr. Djousse has received investigator-initiated grants and honoraria from the food industry, the American Egg Board, Amarin Pharma, and Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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