Drivers of Coronary Disease

Coronary artery disease, a leading cause of death worldwide, is associated with both genetic and lifestyle factors. A familial pattern in the disease was first described in 1938 and later confirmed in studies. Significant evidence has also shown that those who follow a healthy lifestyle have reduced rates of cardiovascular events.

A review of four studies, funded by the National Institutes of Health and others, involving 55,685 participants, analyzed the extent to which increased genetic risk can be offset by a healthy lifestyle.

Genetic risk for the disease was quantified in three cohorts—7814 participants in the Atherosclerosis Risk in Communities, 21,222 in the Women’s Genome Health Study, and 22,389 in the Malmö Diet and Cancer Study. In addition, 4260 participants were in the cross-sectional BioImagine Study for whom genotype and covariate data were available.

Four factors were considered in adherence to a healthy lifestyle among participants: no current smoking, no obesity, regular physical exercise, and a healthy diet.

It was found that the risk of coronary events was 91% higher among those of high genetic risk than among the low genetic risk quintile. Those who adhered to at least three of the healthy lifestyle factors had a substantially lower risk of coronary events than those who adhered to only one, or no, healthy lifestyle factors, regardless of the genetic risk category.

For those at high genetic risk who followed a healthy lifestyle, there was a 46% lower relative risk of coronary artery disease than those with an unfavorable lifestyle.