Editorial: Clean Living as published in the Valley News Nov. 18, 2016

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Editorial: Clean Living

Friday, November 18, 2016

Medical information can be confusing, and it’s often contradictory. But evidence continues to mount that diet, weight and exercise play a vitally important role in maintaining good health. (Just what you need to hear days before the great American feast, eh?)

Researchers at Massachusetts General Hospital recently announced that four lifestyle factors appear to reduce the risk of heart disease, the leading cause of death worldwide. If that finding doesn’t sound so surprising, consider this: those same factors cut in half the risk in people with a genetic predisposition for heart disease.

Good habits, in other words, apparently counteract bad genes.

Genes and lifestyle factors are the key drivers of coronary artery disease. It’s long been known that people whose family members suffer from heart disease are at greater risk, and analyses of the human genome since 2007 have identified more than 50 genes associated with the disease; these genes can help predict the likelihood of a coronary event.

At the same time, however, studies have demonstrated that people who adhere to a healthy lifestyle have a reduced risk of cardiovascular disease. The opposite is also true: Smoking, obesity and sedentary habits put people at a higher risk, especially if they also suffer from high blood pressure and/or diabetes.

The challenge for medical researchers was to tease apart the influence of these drivers, to determine how they act both independently and in conjunction with one another. They looked at 55,000 people with varying degrees of genetic risk for heart disease and tracked their “healthy lifestyle” habits, as defined by the American Heart Association: no smoking, no obesity, moderate physical activity and a diet consisting of fruits, nuts, vegetables, whole grains, fish, dairy products and small amounts of refined grains, processed meats, unprocessed red meats, sugar-sweetened drinks, trans fats and sodium.

Then they crunched the data.

Some results were predictable. People with the highest genetic risk for heart disease had nearly twice the chance of developing heart problems than people with the least genetic risk. The same was true for people who had poor lifestyle habits in comparison with those who maintained healthy habits.

But when researchers studied the effect of genetics and lifestyle combined, they discovered that healthy habits substantially lessened the genetic risk — by as much as 50 percent among some groups.

Even though doctors have long urged their patients — both those with an inherited risk of heart disease and those without — to eat right, exercise, not to smoke and so on, this study strengthens the case for what some call “clean living” and offers evidence that biology is not destiny.

It also adds to the argument that health care delivery strategies would do well to emphasize the benefits of health and wellness. Vermont, for example, is keen to pursue the potential of “accountable care organizations,” which aim to lower the growth of health spending by providing coordinated care to populations of patients. Reimbursement for services is then tied to the overall health of that population. The model has yet to prove its efficacy on a grand scale. But if good habits and lifestyle factors are as influential as this recent MGH study suggests, then doctors will have an even greater incentive to prescribe clean living and to monitor the results.



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