Leading a healthier lifestyle can help offset genetic heart disease risk

• Multiple components contribute to heart health risks, including someone’s genetics and lifestyle.
• One study found that people at a higher genetic risk for cardiovascular disease may benefit most from making favorable lifestyle modifications.
• People interested in making lifestyle changes to reduce cardiovascular disease risk can work with their doctors to adapt habits and prioritize interventions.

Cardiovascular disease is something that contributes to mortality all over the world. The heart and vascular system are critical to health, making it a key area of health research.

Researchers are interested in identifying who is most at risk for cardiovascular disease and what interventions are most helpful in modifying risk.

A study recently published in Nature Human Behavior looked at polygenic risk scores and lifestyles amongst a Chinese population sample.

The researchers found that high genetic risk coupled with an unfavorable lifestyle was strongly associated with early-onset cardiovascular disease outcomes compared to late-onset outcomes.

The study further found that adopting a favorable lifestyle was associated with just over a 14-fold reduction in early-onset coronary artery disease for people with the highest level of genetic risk and reductions in early-onset ischemic stroke and late-onset coronary artery disease, as well.

The findings point to the importance of lifestyle interventions, particularly for younger people with a higher genetic risk for cardiovascular disease.

Unhealthy lifestyle compounds genetic risk for heart disease

This was a prospective cohort study. The research specifically focused on Chinese adults and utilized data from the China Kadoorie Biobank.

Researchers included 96,400 adults in their analysis, and they excluded people with histories of heart attacks or strokes. Researchers divided participants into two sets: A testing set of 72,149 participants and a training set of 24,251 individuals. The average age of participants was 53.

First, researchers constructed polygenic risk scores which evaluate genetic risk for three components of cardiovascular disease: coronary artery disease , ischemic stroke , and intracerebral hemorrhage (brain bleeding) .

They did this using the training set of participants. Then, they used the testing set to look at the age of onset of cardiovascular disease outcomes and the contributions of genetic risk and lifestyles.

To assess lifestyle, researchers divided participants into three groups: favorable, intermediate, and unfavorable.

Individuals were considered to have an unfavorable lifestyle for components like currently smoking, not eating fruits or vegetables daily, low physical activity, and having a high or low body mass index.

Researchers also divided participants into three groups based on genetic risks: low, intermediate, or high.

The authors of the current study note that cardiovascular disease among younger individuals has gone up in recent years, making looking at this group of particular interest.

They categorized cardiovascular disease as either early onset, which was in men less than 55 or in women less than 65, or late-onset, which was in men age 55 or older or in women age 65 or older.

The study found that higher genetic risk was more strongly associated with early-onset cardiovascular disease outcomes rather than late-onset cardiovascular disease outcomes.

Unfavorable lifestyles were also associated with a greater risk for all three cardiovascular disease outcomes in participants under 60 compared to older participants.

Overall, participants with the highest genetic risk and unfavorable lifestyles had the greatest risk for cardiovascular disease outcomes.

Lifestyle interventions can reduce genetic risk 14-fold

The study thus suggests that people with higher genetic risk for cardiovascular disease problems would benefit most from lifestyle changes.

The researchers found that the high genetic risk group had a 14.7-fold risk reduction in incidences of early-onset coronary artery disease, a 2.5-fold risk reduction in early-onset ischemic stroke, and a 2.6-fold decrease in late-onset coronary artery disease when changing to a favorable lifestyle from an unfavorable one.

Cheng-Han Chen, MD , a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, not involved in this research, commented with his thoughts on the study to Medical News Today .

“This study analyzed a large cohort of Chinese patients for certain genetic variants associated with increased risk of cardiovascular disease and found that a higher risk score (composed of specific variants) was associated with increased incidence of early onset of cardiovascular disease,” he explained.

Chen noted that:

“In addition, it found that the rates of ‘unfavorable lifestyle’ — such as smoking, physical inactivity, overweight — were both associated with, and could modify, future risk of developing cardiovascular disease […] As this study found that improvement in lifestyle factors could potentially decrease the risk of developing cardiovascular disease even in people with a higher genetic predisposition, we could potentially target lifestyle improvements at those younger patients specifically at higher genetic risk, in order to achieve the largest impact on public health.”

What were the study limitations?

This research does have limitations. First, it focused on a specific group of people, so it is important not to generalize the results to other populations. Future research could focus on other populations or include more diversity.

Researchers also had to rely on some self-reported data from participants, which does not always reflect people’s actual health status and lifestyle and can affect study results.

The authors note that the incidence of cardiovascular disease in adults under 50 was low in the testing set. Because of this, they could not do a separate analysis in this group.

They also did not conduct “a sex-specific joint analysis of genetic risk and lifestyles.” Furthermore, there were differences between the training and testing groups of participants. And the researchers also acknowledge that there were possible lifestyle changes during the follow-up, which could have impacted the results.

Rigved Tadwalkar, MD , a board-certified consultative cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, not involved in this study, noted some of the following clinical implications of the study data.

“The study underscores the critical role of lifestyle modifications in CVD [cardiovascular disease] prevention, especially among those with high genetic risk. By recognizing the additive interaction between genetic and lifestyle factors, clinicians can tailor preventive strategies to maximize patient outcomes. For instance, intensive lifestyle interventions and earlier medical therapies may be warranted for patients with both high genetic risk and unhealthy lifestyles,” he commented.

What lifestyle changes lower heart disease risk?

Taking charge of heart health can be daunting, but people can take practical steps in this area. As noted in the study, the researchers identified several components of an unhealthy lifestyle, such as eating limited amounts of fruits and vegetables, low physical activity levels, and smoking.

People can work with their doctors to figure out how to prioritize lifestyle changes and how to make these changes in realistic ways.

Tadwalkar emphasized that:

“Regular health checkups and monitoring of core CVD risk factors, such as blood pressure, cholesterol levels, and blood sugar are vital. Collaborating with healthcare providers to develop a personalized prevention plan is of the utmost importance for optimizing cardiovascular health and reducing the risk of events, as those without such a plan run the risk for poorer outcomes.”

Salazar further noted that: “Healthy lifestyle changes include smoking cessation, healthy weight management through diet and increased physical activity. A healthy diet should be rich in vegetables, fruits, whole grains, healthy fats like olive oil and healthy protein sources including fish and legumes.”

“Physical activity recommendations include 20-30 minutes of physical activity 4-5 days per week. People should speak to their physicians about lifestyle changes and medications to improve their modifiable risk factors especially related to smoking cessation, diabetes, high cholesterol and healthy weight management,” he advised.