Prevalence of healthy lifestyle behaviors after a CV event low worldwide

The prevalence of healthy lifestyle behaviors, such as regular physical activity and no smoking, was low among patients with a CHD or stroke event from countries with varying income levels, and even lower in poorer countries, according to new research in JAMA.

The prospective PURE study enrolled 153,996 participants aged 35 to 70 years between January 2003 and December 2009. Participants were from 628 urban and rural communities in three high-income countries, seven upper-middle-income countries, three lower-middle-income countries and four low-income countries. Researchers analyzed smoking status (current, former, never), physical activity level (low, moderate or high, as gauged by metabolic equivalent task) and diet using self reports and food frequency questionnaires.

Koon Teo

Overall, 7,519 (4.9%) of participants had a self-reported CHD or stroke event. The median interval from event to study enrollment was 5 years for CHD and 4 years for stroke, according to the abstract.

Among the 7,519 participants with CHD or stroke, 18.5% continued to smoke, 35.1% had high levels of work- or leisure-related physical activity and 39% followed a healthy diet.

Additionally, 14.3% of participants did not follow any of the three healthy lifestyle behaviors and only 4.3% followed all three.

Among participants with a history of smoking, 52.5% quit smoking. Prevalence of smoking cessation was highest in high-income countries (74.9%) and lowest in low-income countries (38.1%). Researchers reported graded decreases by decreasing country income status (56.5% in upper-middle-income countries and 42.6% in lower-middle-income countries).

Low-income countries had the lowest prevalence of participants who followed a healthy diet (25.8%), compared with lower-middle-income countries (43.2%), upper-middle-income countries (45.1%) and high-income countries (43.4%).

In countries with increasing income, levels of physical activity were increased; however, this finding was not significant.

“This study shows that a large gap exists globally between actual and ideal participation in the three key lifestyle behaviors of avoidance (or quitting) of smoking, undertaking regular physical activity and eating a healthy diet after a CHD or stroke event,” Koon Teo, MB, PhD, professor in the department of medicine, McMaster University, Hamilton, Ontario, Canada, and colleagues wrote in the study. “These patterns were observed worldwide but more so in poorer countries.”

For more information:

Teo K. JAMA. 2013;309:1613-1621.

Disclosure: See the full study for a list of the researchers' relevant financial disclosures.