Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden. The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). Risk-factor changes in wives with husbands at high risk of coronary heart disease (CHD): The spin-off effect Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Effect of lifestyle changes on atherogenic lipids and endothelial cell adhesion molecules in young adults with familial premature coronary heart disease. Coronary Heart Disease Risk Reduction Intervention Among Overweight Smokers with a Psychotic Disorder: Pilot Trial Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus. Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death. EFFECT OF DIET AND SMOKING INTERVENTION ON THE INCIDENCE OF CORONARY HEART DISEASE: Report from the Oslo Study Group of a Randomised Trial in Healthy Men [A prospective study on smoking, quitting and mortality in a cohort of elderly in Xi'an, China]. Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements? Alcohol and coronary heart disease: the roles of HDL-cholesterol and smoking. Smoking cessation following admission to a coronary care unit Risk factors for sudden and non-sudden coronary death. Random fasting hyperglycemia as cardiovascular risk factor in the elderly: A 6‐year longitudinal study United Kingdom Heart Disease Prevention Project: 12-year follow-up of risk factors. Apolipoprotein E4 and coronary heart disease in middle-aged men who smoke: a prospective study Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease White blood cell count and the risk of coronary heart disease and all-cause mortality in elderly men. Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease Quitting and restarting smoking: cohort study of patients with angina in primary care Multivariate Prediction of Coronary Heart Disease in the Western Collaborative Group Study Compared to the Findings of the Framingham Study Association of LPA Variants With Risk of Coronary Disease and the Implications for Lipoprotein(a)-Lowering Therapies: A Mendelian Randomization Analysis Life-course socioeconomic position and incidence of coronary heart disease: the Framingham Offspring Study. Randomised controlled trial of anti-smoking advice: final (20 year) results.
STUDY OBJECTIVE : To investigate differences between smokers and non-smokers in health behaviour , cardiovascular risk factors , coronary heart disease ( CHD ) risks , health knowledge , health attitudes , and compliance with a CHD prevention programme . DESIGN : Differences between smokers and non-smokers were studied via medical examinations , question naires , physical exercise activity logs , and food record sheets . Data were analysed using univariate and multivariate analyses . The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate . SETTING : The Karolinska Hospital , Stockholm , and Sollentuna Primary Health Centre , Sollentuna , Sweden . PARTICIPANTS : The analyses were based on 158 healthy smoking and non-smoking men aged 35 - 60 years with raised cardiovascular risk factors who enrolled in controlled , r and omised six month diet and exercise programmes .  MAIN RESULTS : Discriminant analysis suggested that smokers , compared with non-smokers , were characterised by a higher alcohol energy percent , lower HDL cholesterol concentration , lower systolic blood pressure , and a higher plasminogen activator inhibitor-1 ( PAI-1 ) value . Knowledge of the risk factors for CHD was not a discriminating factor . Both smokers and non-smokers increased the exercise taken , improved their diet , and lowered their CHD risk . Before , as well as after the intervention , smokers had a higher CHD risk than non-smokers . CONCLUSIONS : The best CHD prevention action that could be taken by smokers would of course be to quit smoking . Those who can not stop should be encouraged to improve their diet and increase the amount of  physical exercise  they take in order to reduce the health hazards of their smoking behaviour The impact of smoking cessation on coronary heart disease ( CHD ) and lung cancer was assessed after 10.5 years of follow-up in the 12,866 men in the Multiple Risk Factor Intervention Trial ( MRFIT ) . Those men who died of lung cancer ( n = 119 ) were either cigarette smokers at entry or ex-smokers ; no lung cancer deaths occurred among the 1,859 men who reported never smoking cigarettes . The risk of lung cancer for smokers , adjusted for selected baseline variables using a Cox proportional hazards model , increased as the number of cigarettes smoked increased ( B = 0.0203 , SE = 0.0076 ) . There was not the same grade d response for CHD among smokers at entry . The risk of CHD death was greater among smokers than nonsmokers ( RR = 1.57 ) ( B = -0.0034 , S.E. = 0.0048 ) . After one year of cessation , the relative risk of dying of CHD for the quitters as compared to non-quitters ( RR = 0.63 ) was significantly lower even after adjusting for baseline differences and changes in other risk factors . The relative risk for smokers who quit for at least the first three years of the trial was even lower compared to non-quitters ( RR = 0.38 ) . However , the relative risk for lung cancer for quitters versus non-quitters was close to 1 both for quitters at 12 months and at three years . These data support the benefits of cessation in relation to CHD and are consistent with other epidemiologic studies which suggest that the lag time for a beneficial effect of smoking cessation on lung cancer may be as long as 20 years This study of 220 wives of participants from four of the 22 clinics in the Multiple Risk Factor Intervention Trial ( MRFIT ) addresses the question of whether spouses of men exposed to a continuous coronary heart disease ( CHD ) risk-factor intervention program ( SI group )  make changes in their own risk status compared to wives of men who did not receive the intervention program ( UC group ) .  Total serum cholesterol and low-density lipopro-tein ( LDL ) cholesterol were significantly lower for the SI wives . These differences were found for both hypertensive and normotensive wives , although the magnitudes were much greater for the hypertensive wives . There were also significant differences between the two groups of wives in the food-record rating and in dietary-knowledge scores , indicating that the probable mechanism for the beneficial effect of the intervention with respect to cholesterol levels was the change in the family diet . Although not statistically significant , differences indicating a lower risk for SI wives were found for diastolic blood pressure . There was also a greater mean reduction in cigarettes per day for SI wives who smoked The Multiple Risk Factor Intervention Trial was a r and omized clinical study to test whether a special-intervention ( SI ) program aim ed at reducing serum cholesterol levels , blood pressure and cigarette smoking would prevent coronary heart disease ( CHD ) in middle-aged men . The main endpoint reported here is the percentage of participants experiencing first major CHD events ( either nonfatal acute myocardial infa rct ion [ AMI ] or CHD death ) during 7 years of follow-up . This outcome was slightly less frequent in the 6,428 SI men than in the 6,438 men assigned to their usual source of care ( UC ) . However , the relative difference -- either 1 % ( 95 % confidence interval -17 % to 16 % ) or 8 % ( 95 % confidence interval -5 % to 20 % ) , depending on how AMI was classified -- was not statistically significant . Regression analyses within the SI and UC groups suggested that the cholesterol and cigarette smoking interventions reduced the number of first major CHD events : the associations between lowering the levels of these 2 factors and reductions in CHD rates were significant ( p less than 0.001 ) and of the anticipated magnitude . A similar analysis of antihypertensive treatment in the SI group revealed no favorable association between lowering blood pressure and CHD rate , and other subgroup comparisons suggested that a mixture of beneficial and adverse effects may underlie this finding . Thus , the nonsignificant overall UC/SI contrast in CHD rates may reflect a combination of the expected beneficial effects of the cholesterol and smoking interventions with unexpected heterogeneous effects of the antihypertensive intervention . Seven of 8 other prespecified cardiovascular endpoints occurred less frequently among SI than among UC men , the difference being nominally significant ( p less than 0.05 ) for angina pectoris , congestive heart failure and peripheral arterial disease Guidelines have recommended that a family history of premature coronary heart disease ( CHD ) warrants screening and preventive efforts , including lifestyle change . The objective of this study was to evaluate the effects of a lifestyle modification program on lipids and novel risk markers in young relatives of patients with premature CHD . In a parallel , r and omized , intervention trial , intensified support to quit smoking and dietary modification was compared with general lifestyle advice in 172 men and women aged 18 to 39 years with a total cholesterol of 5 to 8 mmol/L and > or=1 lipid abnormality ( high low-density lipoprotein [ LDL ] cholesterol , triglycerides or lipoprotein(a ) , or low high-density lipoprotein cholesterol ) . All had a first-degree relative with premature CHD or with hyperlipidemia and other relative(s ) with premature CHD , and 40 % were daily smokers . After a mean of 8 months , the intervention group reduced the dietary intake of saturated fat and cholesterol compared with controls ( p = < 0.01 ) . Ten smokers in the intervention group quit , whereas 2 subjects in the control group started and none quit . LDL cholesterol ( p = 0.007 ) , oxidized LDL ( p = 0.03 ) , and E-selectin ( p = 0.02 ) concentrations were reduced in the intervention group compared with controls . In subjects who quit smoking , concentrations of intercellular adhesion molecule-1 decreased ( 261 + /- 66 to 228 + /- 30 ng/ml ) compared with that in continuing smokers ( 308 + /- 106 ng/ml to 304 + /- 109 ng/ml ) ( p = 0.05 between groups ) . These findings indicate that dietary modification and smoking cessation are feasible in young adults with familial premature CHD and document novel mechanisms by which lifestyle modification may reduce CHD risk Objective : The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing ( i ) coronary heart disease ( CHD ) risk ; ( ii ) smoking ; and ( iii ) weight among smokers with psychosis . Secondary dependent variables included physical activity , unhealthy eating , substance use , psychiatric symptomatology , treatment retention , general functioning , and quality of life . Method : This was a feasibility study utilizing a pre – post-treatment design with  no control group ( n=43 ) . All participants provided written informed consent and were assessed before treatment and again a mean of 19.6weeks later . The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy , in addition to treatment as usual . Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessment s. Results : The intervention was associated with significant reductions in CHD risk scores , smoking and weight . A significant improvement was also reported in level of moderate physical activity , and a small change in the unhealthy eating index was reported . No improvement in biological measures ( cholesterol and blood pressure ) was evident . Conclusions : A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term . A r and omized controlled trial replicating and extending these findings is warranted BACKGROUND Although the association between smoking and increased risk of coronary heart disease ( CHD ) is well established in the general population , this relationship is less well-defined among individuals with diabetes . OBJECTIVE To assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus in the Nurses ' Health Study cohort . METHODS The Nurses ' Health Study , a prospect i ve cohort study of 121,700 US female registered nurses surveyed in 11 states and followed up from July 1 , 1976 , through July 1 , 1996 , involved a total of 6547 women diagnosed as having type 2 diabetes mellitus . Incident cases of CHD were our main outcome measure in this study . RESULTS We documented 458 incident cases of CHD ( 200 fatal CHD-related cases and 258 nonfatal myocardial infa rct ions ) during 20 years ( 68,227 person-years ) of follow-up . We found a dose-response relationship between current smoking status and risk of CHD among diabetic women . Compared with never smokers , the relative risks ( RRs ) for CHD were 1.21 ( 95 % confidence interval [ CI ] , 0.97 - 1.51 ) for past smokers , 1.66 ( 95 % CI , 1.10 - 2.52 ) for current smokers of 1 to 14 cigarettes per day , and 2.68 ( 95 % CI , 2.07 - 3.48 ) for current smokers of 15 or more cigarettes per day in multivariate analyses ( P<.001 for trend ) . The multivariate RR of CHD among diabetic women who had stopped smoking for more than 10 years was similar to that among diabetic women who were never smokers ( RR , 1.01 ; 95 % CI , 0.73 - 1.38 ) . In secondary analyses involving diabetic and nondiabetic women , the multivariate-adjusted RR of CHD for those with diabetes who currently smoked ( > or = 15 cigarettes per day ) compared with those who never smoked was 7.67 ( 95 % CI , 5.88 - 10.01 ) . CONCLUSIONS Cigarette smoking is strongly associated with an increased risk of CHD  among women with type 2 diabetes mellitus . Furthermore , quitting smoking seems to decrease this excess risk substantially ; women with diabetes should be strongly advised against smoking . Large observational studies , r and omized clinical trials , and experimental studies have evaluated the effects of fish and n-3 fatty acid consumption on  fatal coronary heart disease ( CHD ) and sudden cardiac death ( SCD )  , clinical ly defined events that most often share the final common pathway of fatal ventricular arrhythmia . These different study design s , each having complementary strengths and limitations , provide strong concordant evidence that modest consumption of fish or fish oil ( 1 - 2 servings/wk of oily fish , or approximately 250 mg/d of EPA+DHA ) substantially reduces the risk of CHD death and SCD . Pooled analysis of prospect i ve cohort studies and r and omized clinical trials demonstrates the magnitude and dose-response of this effect , with 36 % lower risk of CHD death comparing 0 and 250 mg/d of EPA+DHA consumption ( P < 0.001 ) , but then little additional benefit with higher intakes . Reductions in risk are even larger in observational studies utilizing tissue biomarkers of n-3 fatty acids that more accurately measure dietary consumption . The concordance of findings from different studies also suggests that effects of fish or fish oil on CHD death and SCD do not vary depending on presence or absence of established CHD . The strength and consistency of the evidence , and the magnitude of this effect are each notable . Because more than one-half of all CHD deaths and two-thirds of SCD occur among individuals without recognized heart disease , modest consumption of fish or fish oil , together with smoking cessation and regular moderate physical activity , should be among the first-line treatments for prevention of CHD death and SCD 16 202 men , aged 40 - 49 years , were screened for coronary risk factors , Of these , 1232 healthy , normotensive men at high risk of coronary heart disease ( CHD ) were selected for a 5-year r and omised trial to show whether lowering of serum lipids and cessation of smoking could reduce the incidence of CHD . Men were admitted to the trial if they had serum cholesterol levels of 7.5 - 9.8 mmol/l ( 290 - 380 ) mg/dl ) , coronary risk scores ( based on cholesterol levels , smoking habits , and blood pressure ) in the upper quartile of the distribution , and systolic blood pressures below 150 mm Hg ( mean of two measurements ) . The men in the intervention group were recommended to lower their blood lipids by change of diet and to stop smoking .  Mean serum cholesterol concentrations were approximately 13 % lower in the intervention group than in the control group during the trial ( based on the difference between the mean of 3 prer and omisation values and the mean of yearly values during the trial ) . Mean fasting serum triglycerides fell by 20 % in the intervention group compared with controls . 80 % of the men in both groups smoked tobacco daily at the start of the study . The mean tobacco consumption per man decreased by 45 % more in the intervention group than in the control group . However , only 25 % of the smokers in the intervention group completely stopped smoking compared with 17 % in the control group . Diagnosis of events of cardiovascular disease during the study was made blindly according to predefined criteria by two cardiologists not involved in the study . At the end of the observation period the incidence of myocardial infa rct ion ( fatal and non-fatal ) and sudden death was 47 % lower in the intervention group than in the controls ( p = 0.028 , two-tailed log rank test ) . When the incidence of strokes was added , the difference between the groups was still significant . It is concluded that in healthy middle-aged men at high risk of CHD advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of myocardial infa rct ion and sudden death . Statistical analysis , by Cox 's proportional hazards model shows that the reduction in incidence in the intervention group is correlated with the reduction in total cholesterol and to a lesser extent with smoking reduction OBJECTIVE To prospect i ve examine the relationship between smoking , quitting and mortality in older Chinese men by in Xi'an , China . METHODS The design was a cohort analytic study . One thous and two hundred and sixty-eight retired male military veterans aged 60 or older were examined in 1987 . At baseline , there were 388 never-smokers , 461 former smokers and 419 current smokers . Main outcome measure was all-cause and tobacco-associated mortality . RESULTS Through 1999 , 299 had died , 943 were alive and 26 lost . The mean follow-up time was 11 years and total person-year of follow-up was 14 163 . After adjusting for age , blood pressure , body mass index , total cholesterol , triglycerides , alcohol intake , exercise and existing diseases , using Cox proportional hazard regression model , the relative risks ( 95 % confidence intervals ) for ever-smoking , deaths result ing from all causes , chronic obstructive pulmonary disease ( COPD ) , lung cancer and coronary heart disease ( CHD ) were 1.34 ( 1.02 - 1.76 ) , 3.23 ( 0.95 - 10.91 ) , 2.31 ( 0.95 - 5.61 ) and 1.60 ( 0.81 - 3.19 ) respectively . The risks increased significantly with increasing amount and duration of smoking . Compared with current smokers , former smokers had lower risks of total mortality ( excess risk reduction of 56 % ) and from CHD death ( 93 % ) , but had higher risks for COPD death ( excess risk increased 174 % ) . CONCLUSIONS Smoking is a major cause of death in older Chinese men and quitting can save lives . These results showing that higher risks of COPD death in former smokers with or without existing diagnosed COPD at baseline than those in current smokers could be explained by either the " healthy smoker effect " or the " ill quitter effect " or both . Early recognition of the significance of COPD symptoms followed by prompt quitting should be emphasized as strategies in the control of the growing tobacco epidemic Background It is unclear how much of the reduction in cardiac mortality in coronary heart disease ( CHD ) patients with exercise training  is the result of direct effects on the heart and coronary vasculature , or to indirect effects , via primary risk factors . Objective The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature . Methods The IMPACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta- analysis of cardiac rehabilitation r and omized , controlled trials . Patients were receiving rehabilitation following an acute myocardial infa rct ion , angina pectoris or revascularization . Outcomes considered were primary risk factors ( total cholesterol , systolic blood pressure and smoking behaviour ) and cardiac mortality . Results Nineteen exercise-only cardiac rehabilitation trials ( including 2984 patients ) were identified . Across these trials , exercise training reduced pooled cardiac mortality by 28 % ( relative risk , 0.72 , 95 % confidence interval 0.55–0.95 ) , with 30 fewer deaths than in the control group . Applying the CHD model , approximately 17 ( 58 % ) of these 30 fewer deaths were attributable to reductions in major cardiovascular risk factors : 7.1 deaths ( minimum estimate 6.2 , maximum estimate 9.5 ) attributable to an 18 % reduction in smoking prevalence ; 5.9 deaths ( minimum −0.6 , maximum 12.6 ) to a 0.11 mmol/l reduction in cholesterol , and 4.4 deaths ( −1.0 minimum , 6.7 maximum ) to a 2.0 mmHg reduction in systolic blood pressure . Conclusions Approximately half of the 28 % reduction in cardiac mortality achieved with exercise-based cardiac rehabilitation may be attributed to reductions in major risk factors , particularly smoking . Eur J Cardiovasc Prev Rehabil 13:369–374 © 2006 The European Society of OBJECTIVES To study the role of HDL-cholesterol ( HDLc ) in the causal pathway mediating the effect of alcohol on coronary heart disease ( CHD ) .  DESIGN Cox proportional hazard models were used to compare the relative CHD risks in various HDLc-smoking categories . SETTING A prospect i ve , multicentre , placebo-controlled , double-blind CHD primary prevention trial with gemfibrozil in primary ( occupational ) health care units , the Helsinki Heart Study . SUBJECTS Dyslipidaemic middle-aged men with available alcohol consumption data ( 1924 of 2035 ) in the placebo arm of the 5-year study . MAIN OUTCOME MEASURES Seventy-seven ( of 84 ) cases of nonfatal myocardial infa rct ion or cardiac death . RESULTS A U-shaped association was detected between alcohol consumption and CHD . The protection was found both in subjects with low ( mean 0.94 mmol L-1 ) and normal ( mean 1.25 mmol L-1 ) HDLc with corresponding reductions of 23 % and 36 % in relative risks . In contrast to previous data , alcohol offered virtually no protection against CHD in non-smokers . In subjects consuming more than 800 g pure ethanol annually , the CHD incidence was 6/1000 in subjects with more than three weekly drinking occasions , compared to 11/1000 in ' weekend ' drinkers . CONCLUSIONS Our results confirm the protective effect of alcohol against CHD . However , in contrast to previous data the effect in our population is restricted to smokers and the role of HDLc in mediating the effect is less central than suggested previously Objective : To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting . Design : Prospect i ve observational study in which smokers admitted to a coronary care unit ( CCU ) were followed for one year after hospital discharge to determine subsequent smoking behavior . Setting : Coronary care unit of a teaching hospital . Patients : Preadmission  smoking status was assessed in all 828 patients admitted to the CCU during one year . The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months . Intervention : None . Measurements and main results : Six months after discharge , 32 % of survivors were not smoking ; the rate of sustained cessation at one year was 25 % . Smokers with a new diagnosis of coronary heart disease ( CHD ) made during hospitalization had the highest cessation rate ( 53 % vs. 31 % , p=0.01 ) . On multivariate analysis , smoking cessation was more likely if patients were discharged with a diagnosis of CHD , had no prior history of CHD , were lighter smokers ( < 1 pack/day ) , and had congestive heart failure during hospitalization . Among smokers admitted because of suspected myocardial infa rct ion ( MI ) , cessation was more likely if the diagnosis was CHD than if it was noncoronary ( 37 % vs. 19 % , p<0.05 ) , but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency . Conclusion : Hospitalization in a CCU is a stimulus to long-term smoking cessation , especially for lighter smokers and those with a new diagnosis of CHD . Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention . Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality , even when quitting occurs after the onset of CHD The impact of risk factors for sudden and non-sudden coronary death was investigated in 3,589 Finnish men aged 40 - 59 years at entry from a prospect i ve population survey .  During a mean follow-up time of 11 years , 234 coronary deaths occurred , 150 of which were sudden , i.e. ensuing within 1 hour of the onset of symptoms . The severity of the manifestations of CHD at baseline investigation appeared to be a powerful predictor of sudden coronary death . Smoking and high serum cholesterol were significant predictors of sudden coronary death . High serum cholesterol was an equally significant predictor of sudden and non-sudden coronary death . High blood pressure did not appear to significantly increase sudden coronary death but increased the incidence of non-sudden death significantly . Obesity and diabetes did not appear to be independent risk factors for sudden coronary death . Smoking and high serum cholesterol were significant risk factors for sudden coronary death in men with manifestations of coronary heart disease . The results suggest that reduction of primary risk factors , especially smoking and high serum cholesterol , is important even after coronary heart disease has become manifest A large body of evidence suggests that diabetes increases the risk of coronary heart disease ( CHD ) , but whether fasting hyperglycemia is associated with a major risk for CHD is still under debate . The aim of the present study was to investigate the role played by fasting hyperglycemia in the development of cardiovascular disease ( CVD ) in an elderly population when associated with common risk factors for CVD ( i.e. , hypertension , hypercholesterolemia , smoking , etc ) . We analyzed a sample of 455 subjects aged ± 60 years . The risk factors taken into account were systolic and diastolic blood pressure levels , use of antihypertensive drugs , total serum cholesterol , serum triglycerides , and smoking habit  . Glycemia was measured at entry on a fasting sample . During the follow‐up period ( mean 6 years ) , the occurrence of CVD was monitored ( criteria for the occurrence of CVD included total cardiovascular mortality , fatal or nonfatal myocardial infa rct ion , symptomatic coronary heart disease [ stable and unstable angina ] , the need for percutaneous transluminal coronary angioplasty or coronary artery bypass graft , fatal or nonfatal stroke , and transient ischemic attack ) . A total of 427 subjects completed the follow‐up . During this period , 73 subjects ( 17.10 % ) developed CVD according to the above criteria . A Cox proportional hazard model was design ed to evaluate the contribution of variables in predicting CVD . Relative risks and 95 % confidence intervals for CVD were calculated from the regression coefficients to study the association between the risk of developing CVD and predicting variables . We found a relation between occurrence of CVD and fasting hyperglycemia : subjects with fasting glycemia , > 126 mg/dl at enrollment , but without previous clinical diagnosis of diabetes , showed a 2.01 times higher risk than those with fasting glycemia < 126 mg/dl . Hence , r and om fasting hyperglycemia can predict the occurrence of CVD in elderly subjects Ten of the original 24 factories from the United Kingdom Heart Disease Prevention Project were resurveyed in 1983 to assess the long-term ( 12-year ) effects of an education program on  diet , smoking , and exercise .  These 10 factories had previously been grouped into five pairs matched for size , location , and nature of industry , with one of each pair r and omly chosen for intervention . Men in intervention factories were given advice on reduction of cholesterol in diet , stopping smoking , weight reduction , and regular exercise .  High-risk workers ( 13 % ) received personal counseling in addition to the factory-wide education program . A total of 1,204 workers r and omly selected from those still employed in 1978 were surveyed . There were significant differences observed in cigarette consumption , butter use , and several other dietary behaviors ; however , the differences were small and insignificant for the proportion smoking and leisure-time exercise . The largest effects were in the high-risk group who had received personal counseling . This education program appears to have some lasting effects on behavior associated with coronary disease risk factors . Similarly design ed programs may serve as models for community-wide coronary disease prevention programs BACKGROUND The common isoforms of apolipoprotein E ( apoE ) , E2 , E3 , and E4 , are important determinants of plasma lipid concentrations , and the epsilon4 allele is associated with raised risk of coronary heart disease . We investigated whether the effect of smoking on coronary heart disease risk is affected by APOE genotype . METHODS We enrolled 3052 middle-aged men who were free of coronary heart disease for prospect i ve cardiovascular surveillance in the second Northwick Park Heart Study ( NPHSII ) . Smoking habit was ascertained at baseline and yearly by question naire . APOE genotype was identified by PCR and restriction enzyme digestion . Endpoints were fatal coronary heart disease , non-fatal myocardial infa rct ion , and coronary artery surgery and silent myocardial infa rct ion at follow-up . FINDINGS During 18836 person years of surveillance , 96 men had an acute myocardial infa rct ion , 26 needed coronary artery surgery , and 14 had silent myocardial infa rct ions . Compared with never-smokers , risk of coronary heart disease in ex-smokers was 1.34 ( 95 % CI 0.86 - 2.08 ) and in smokers it was 1.94 ( 1.25 - 3.01 ) . This risk was independent of other classic risk factors . In never-smokers , risk was closely similar in men with different genotypes . Risk in men homozygous for the epsilon3 allele was 1.74 ( 1.10 - 2.77 ) in ex-smokers and 1.68 ( 1.01 - 2.83 ) in smokers , whereas in men carrying the epsilon4 allele risk was 0.84 ( 0.40 - 1.75 ) and 3.17 ( 1.82 - 5.50 ) , respectively , with no significant differences in risk in the epsilon2 carriers . For the epsilon3 group , the genotype effect on risk was no longer significant after adjustment for classic risk factors ( including plasma lipids ) . However , even after adjustment , smokers who were carriers of the epsilon4 allele , showed significantly raised risk of coronary heart disease compared with the non-smoking group ( 2.79 , 1.59 - 4.91 , epsilon4-smoking interaction p=0.007 ) . INTERPRETATION Smoking increases the risk of coronary heart disease in men of all genotypes but particularly in men carrying the epsilon4 allele Abstract Objective : To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses ' Health Study . Design : Prospect i ve cohort study . Setting : Nurses ' Health Study . Subjects : 86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease , stroke , or cancer at baseline in 1980 . Main outcome measures : Major coronary heart disease including non-fatal myocardial infa rct ion and fatal coronary heart disease . Results : 1255 major coronary disease events ( 861 cases of non-fatal myocardial infa rct ion and 394 cases of fatal coronary heart disease ) occurred during 14 years of follow up . After adjusting for age , smoking , and other known risk factors for coronary heart disease , women who ate more than five units of nuts ( one unit equivalent to 1 oz of nuts ) a week ( frequent consumption ) had a significantly lower risk of total coronary heart disease ( relative risk 0.65 , 95 % confidence interval 0.47 to 0.89 , P for trend=0.0009 ) than women who never ate nuts or who ate less than one unit a month ( rare consumption ) . The magnitude of risk reduction was similar for both fatal coronary heart disease ( 0.61 , 0.35 to 1.05 , P for trend=0.007 ) and non-fatal myocardial infa rct ion ( 0.68 , 0.47 to 1.00 , P for trend=0.04 ) . Further adjustment for intakes of dietary fats , fibre , vegetables , and fruits did not alter these results . The inverse association persisted in subgroups stratified by levels of smoking , use of alcohol , use of multivitamin and vitamin E supplements , body mass index , exercise , and intake of vegetables or fruits . Conclusions : Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infa rct ion . These data , and those from other epidemiological and clinical studies , support a role for nuts in reducing the risk of coronary heart disease Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males Because the importance of established risk factors for coronary heart disease ( CHD ) is unclear in older people , the associations of white blood cell ( WBC ) count with the risk for CHD and all-cause mortality were investigated in an elderly cohort that was followed up for 5 years . In 1985 , complete information on the risk factors of interest was available for 884 r and omly selected men , aged 64 to 84 years , from the Dutch town of Zutphen ( participation rate , 74 % ) .  Relative risks ( RRs ) for each 10(9)/L increase in WBC count were obtained for the 5-year incidence of and mortality from CHD and all causes . RRs were adjusted for age , body mass index , systolic blood pressure , total and high density lipoprotein cholesterol levels , and cigarette smoking habit . The WBC count was 6.7 + /- 1.8 X 10(9)/L ( means + /- SD ) at baseline . An increased WBC count was independently associated with mortality due to CHD , and the RR amounted to 1.32 ( 95 % confidence interval [ 95 % CI ] , 1.15 to 1.51 ) . For the incidence of CHD the RR was 1.14 ( 95 % CI , 0.98 to 1.32 ) . These associations were observed regardless of cigarette smoking habit . Regarding all-cause mortality , the RR amounted to 1.25 ( 95 % CI , 1.17 to 1.35 ) . This association was especially noticeable among former smokers and those who had never smoked . In conclusion , during 5 years of follow-up WBC count predicted CHD and all-cause mortality  in elderly men , independent of the conventional risk factors for CHD Background Smoking cessation is probably the most important action to reduce mortality after a coronary event . Smoking cessation programs are not widely implemented in patients with coronary heart disease , however , possibly because they are thought not to be worth their costs . Our objectives were to estimate the cost effectiveness of a smoking cessation program , and to compare it with other treatment modalities in cardiovascular medicine . Methods A cost-effectiveness analysis was performed on the basis of a recently conducted r and omized smoking cessation intervention trial in patients admitted for coronary heart disease . The cost per life year gained by the smoking cessation program was derived from the re sources necessary to implement the program , the number needed to treat to get one additional quitter from the program , and the years of life gained if quitting smoking . The cost effectiveness was estimated in a low-risk group ( i.e. patients with stable coronary heart disease ) and a high-risk group ( i.e. patients after myocardial infa rct ion or unstable angina ) , using survival data from previously published investigations , and with life-time extrapolation of the survival curves by survival function modeling . Results In a lifetime perspective , the incremental cost per year of life gained by the smoking cessation program was ∊280 and ∊110 in the low and high-risk group , respectively ( 2000 prices ) . These costs compare favorably to other treatment modalities in patients with coronary heart disease , being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group . In a sensitivity analysis , the costs remained low in a wide range of assumptions . Conclusions A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease Smoking is the most important modifiable risk factor for coronary heart disease and its reduction is a target for primary health care.1 The participants in most studies of the smoking habits of patients with coronary heart disease are enrolled after acute cardiac events.2 There are few documented studies of the changes in the smoking habits of patients with angina . This study examined variations in self reported smoking habits over a five year period in a primary care cohort of patients diagnosed as having angina . Patients clinical ly diagnosed as having angina at least six months previously were identified from the disease registers of 18 general practice s in the Greater Belfast area . These general practice s were chosen to The Western Collaborative Group Study ( WCGS ) is a prospect i ve epidemiological study of 3,154 initially well men , aged 39–59 years at intake in 1960–61 , who were employed in ten participating companies in California . Clinical coronary heart disease ( CHD ) occurred in 257 men during a follow-up period of eight and one-half years . Coronary heart disease risk is predicted using the additive multiple logistic model with the risk factors : age , cholesterol , systolic blood pressure , hematocrit , ECG status , smoking at intake , and relative body weight . The predicted individual CHD risk levels , using the logistic results derived from the WCGS data , are highly correlated with predicted risk levels using a Framingham study ( FS ) equation for these same risk factors with 12-year follow-up . The observed number of CHD events in the WCGS is not significantly different from the expected number of events derived from the FS logistic equation , after correction for length of follow-up . Multiple logistic analysis of the direct association between CHD incidence and behavior pattern gives an approximate relative risk of 1.9 ( P = 0.0006 ) and 2.1 ( P = 0.0015 ) for Type A compared to Type B men aged 39–49 and 50–59 years , respectively . It is estimated that removal of the excess risk associated with Type A behavior would correspond to a 31 % ( st and ard error = 6.6 % ) reduction of coronary heart disease incidence in the Western Collaborative Group Study population Importance Human genetic studies have indicated that plasma lipoprotein(a ) ( Lp[a ] ) is causally associated with the risk of coronary heart disease ( CHD ) , but r and omized trials of several therapies that reduce Lp(a ) levels by 25 % to 35 % have not provided any evidence that lowering Lp(a ) level reduces CHD risk . Objective To estimate the magnitude of the change in plasma Lp(a ) levels needed to have the same evidence of an association with CHD risk as a 38.67-mg/dL ( ie , 1-mmol/L ) change in low-density lipoprotein cholesterol ( LDL-C ) level , a change that has been shown to produce a clinical ly meaningful reduction in the risk of CHD . Design , Setting , and Participants A mendelian r and omization analysis was conducted using  individual participant data  from 5 studies and with external validation using summarized data from 48 studies . Population -based prospect i ve cohort and case-control studies featured 20 793 individuals with CHD and 27 540 controls with individual participant data , whereas summarized data included 62 240 patients with CHD and 127 299 controls . Data were analyzed from November 2016 to March 2018 . Exposures Genetic LPA score and plasma Lp(a ) mass concentration . Main Outcomes and Measures Coronary heart disease .  Results Of the included study participants , 53 % were men , all were of white European ancestry , and the mean age was 57.5 years . The association of genetically predicted Lp(a ) with CHD risk was linearly proportional to the absolute change in Lp(a ) concentration . A 10-mg/dL lower genetically predicted Lp(a ) concentration was associated with a 5.8 % lower CHD risk ( odds ratio [ OR ] , 0.942 ; 95 % CI , 0.933 - 0.951 ; P = 3 × 10−37 ) , whereas a 10-mg/dL lower genetically predicted LDL-C level estimated using an LDL-C genetic score was associated with a 14.5 % lower CHD risk ( OR , 0.855 ; 95 % CI , 0.818 - 0.893 ; P = 2 × 10−12 ) . Thus , a 101.5-mg/dL change ( 95 % CI , 71.0 - 137.0 ) in Lp(a ) concentration had the same association with CHD risk as a 38.67-mg/dL change in LDL-C level . The association of genetically predicted Lp(a ) concentration with CHD risk appeared to be independent of changes in LDL-C level owing to genetic variants that mimic the relationship of statins , PCSK9 inhibitors , and ezetimibe with CHD risk . Conclusions and Relevance The clinical benefit of lowering Lp(a ) is likely to be proportional to the absolute reduction in Lp(a ) concentration . Large absolute reductions in Lp(a ) of approximately 100 mg/dL may be required to produce a clinical ly meaningful reduction in the risk of CHD similar in magnitude to what can be achieved by lowering LDL-C level by 38.67 mg/dL ( ie , 1 mmol/L ) Cumulative exposure to socioeconomic disadvantage across the life course may be inversely associated with coronary heart disease ( CHD ) ; the mechanisms are not fully clear . An objective of this study was to determine whether cumulative life-course socioeconomic position ( SEP ) is associated with CHD incidence in a well-characterized US cohort that had directly assessed childhood and adulthood measures of SEP and prospect ively measured CHD incidence . Furthermore , analyses aim ed to evaluate whether adjustment for CHD risk factors reduces the association between cumulative life-course SEP and CHD . The authors examined 1,835 subjects who participated in the Framingham Heart Study Offspring Cohort from 1971 through 2003 ( mean age , 35.0 years ; 52.4 % women ) .  Childhood SEP  was measured as father 's education ; adulthood SEP  was assessed as own education and occupation .  CHD incidence included myocardial infa rct ion , coronary insufficiency , and coronary death . Cox proportional hazards analyses indicated that cumulative SEP was associated with incident CHD after adjustment for age and sex ( hazard ratio = 1.82 , 95 % confidence interval : 1.17 , 2.85 for low vs. high cumulative SEP score ) . Adjustment for CHD risk factors reduced that magnitude of association ( hazard ratio = 1.29 , 95 % confidence interval : 0.78 , 2.13 ) . These findings underscore the potential importance of CHD prevention and treatment efforts for those whose background s include low SEP throughout life STUDY OBJECTIVE --The aim was to measure experimentally the effects in middle aged men of stopping smoking . DESIGN --The study was a r and omised controlled trial . SETTING AND SUBJECTS -- The subjects were 1445 male smokers , initially aged 40 - 59 years , who were selected from the Whitehall study survey of 16,016 civil servants on the basis of a high risk of cardiorespiratory disease . MAIN RESULTS --During the next 20 years there were 620 deaths ( 231 from coronary heart disease ) , 96 cases of lung cancer , and 159 other cancers . Comparing the intervention with the normal care group , total mortality was 7 % lower , fatal coronary heart disease was 13 % lower , and lung cancer ( deaths+ registration s ) was 11 % lower . An excess rate for other cancers , reported previously , did not persist into the second decade of the trial . CONCLUSIONS --The results are consistent with observational studies , implying that smoking cessation by middle aged men substantially improves their changes of avoiding lung cancer or a fatal heart attack . Our estimate from the trial is that out of every 100 men who stopped smoking , between six and 10 were in consequence alive 20 years later
REVIEW ER 'S CONCLUSIONS Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD .
This 36 % risk reduction appears substantial compared with other secondary preventive therapies such as cholesterol lowering which have received greater attention in recent years .
The risk reduction associated with quitting smoking seems consistent regardless of differences between the studies in terms of index cardiac events , age , sex , country , and time period .
BACKGROUND Although the importance of smoking as a risk factor for coronary heart disease is beyond doubt , the speed and magnitude of risk reduction when a smoker with coronary heart disease quits are still subjects of debate .
OBJECTIVES To estimate the magnitude of risk reduction when a patient with CHD stops smoking .