Beyond secondary prevention drugs: Added benefit in survival and events of a healthy lifestyle in patients after an acute coronary syndrome

Objective

To quantify the added clinical benefit of a healthy lifestyle following an acute coronary syndrome (ACS). Our study seeks to answer the question: Is adherence to medical therapy sufficient or a healthy lifestyle provides additional improvement?.

Methods

This is a prospective observational multi-center study of 685 ACS patients. At 6 months patients were asked about their post-ACS lifestyle and were given a score (range: 0–7) with the following items: Intake of ≥3 fruits and vegetables/day, ≥2 fish servings/week, ≤7 alcohol beverages/week, feeling stress <once/month, moderate-intense physical activity in leisure time, walking at work, and giving up tobacco. One point was assigned for each of these items. Mean follow-up was 4.89 (2.85–7.70) years.

Results

After adjusting for demographic variables, cardiovascular risk factors, characteristics of the index event, high-sensitivity C-reactive protein (hs-CRP), and drug therapy, multivariate Cox regression showed that the lifestyle SCORE was independently and inversely associated with both the incidence of the primary outcome (ischemic events [any ACS, stroke, or Transient Ischemic Attack] or death) (HR 0.65 (CI95 % 0.44–0.96); p = 0.029) and death (HR 0.41 [95 %CI 0.18–0.91]; p = 0.029). Statin therapy was also independently and inversely associated with the incidence of the primary outcome and death. Kaplan-Meier curves showed a higher event-free survival for both outcomes in patients with SCORE≥4 (healthy lifestyle) than in those with SCORE<4 (unhealthy lifestyle). Additionally, patients with a SCORE≥4 had a significantly greater decrease of total cholesterol and hs-CRP. For each 1-point increase in the score, there was a 35 % reduction in the incidence of the primary outcome (ischemic events or death) and a 59 % reduction in the incidence of death.

Conclusion

Among patients with ACS and similar medical therapy, a healthy lifestyle is an independent and added marker of a lower incidence of new ischemic events and death. It is also associated with a better lipid profile and lower inflammation after the ACS. As the prognosis of ACS has improved over the years due to better therapies; this study shows that lifestyle modifications continue to offer significant benefit at this point in time.