Healthy lifestyles can offset genetic heart attack risk

As We See It: Do Healthy Lifestyles Offset Genetic Heart Attack Risk?

A study in the New England Journal of Medicine found that four lifestyle choices help protect against cardiovascular disease. Much more can be done to reduce the risk of heart attack and stroke, including preventive blood testing.

By William Faloon.

William Faloon
William Faloon

Those with a high genetic risk of coronary artery disease are 91% more likely to suffer an adverse cardiac event compared to people with low genetic risk.

A research team evaluated cardiovascular disease incidence among 55,000 participants in a study published in the New England Journal of Medicine.1

The findings reveal that a favorable lifestyle is associated with a 46% lower rate of coronary artery disease at any time point during the study period in people at high genetic risk.1

This 46% lower rate was based on a comparison to individuals at high genetic risk who did not adhere to healthier lifestyles.

What should perk your interest are the four lifestyle choices evaluated. To slash cardiovascular disease risk, all it took were:

  • Healthy diet
  • No current smoking
  • Regular physical activity
  • No obesity

Following just three of four of the above healthier lifestyles yielded benefits.

More aggressive management of vascular risks could have further lowered coronary disease incidence.

This study was not designed to measure cardiovascular disease risk factors in blood (like glucose, homocysteine, apolipoprotein B)2 and blood pressure.

That might explain why there was only a 46% reduction in the high genetic risk group who followed the favorable lifestyles.

This article describes what more can be done to reduce today's number one killer, i.e., heart attack, and also ischemic stroke.3

Genetic and lifestyle factors strongly influence one's risk of coronary artery disease.4

The purpose of a study published in the New England Journal of Medicine was to assess the effects of healthy lifestyles on coronary artery disease risk and the significant increase in burden of coronary artery calcification in people with varying degrees of family history of cardiovascular issues.

DNA sequence was used to quantify genetic risk for coronary artery disease in this large group.

The primary study end point was a composite of events that included heart attack (myocardial infarction), coronary revascularization, and death from coronary causes.

One arm of the study also analyzed coronary calcification scores.

The relative risk of coronary events was 91% higher among people at high genetic risk (top DNA quintile) compared to those at low genetic risk (bottom DNA quintile).

Effect of Favorable Lifestyles

Healthy diet, no current smoking, regular physical activity, and no obesity were associated with decreased rates of coronary artery disease in those with intermediate-to-high family history.

The riskiest behavior was smoking. Non-smokers were 44% less likely to suffer a coronary event, despite higher genetic risk.

Lean individuals were 34% less at risk compared to the obese.

Regular physical activity reduced coronary risk by 12% and healthy diet reduced risk by 9%.

Among participants in the highest genetic risk group, a favorable lifestyle was associated with a 46% lower rate of coronary artery disease compared to high genetic risk individuals who were following unfavorable lifestyles.

A favorable lifestyle was also associated with significantly less coronary-artery calcification in each genetic risk category.

Genetic Risk and Family History

The DNA genotype in this study was used in an attempt to correlate coronary artery disease with family history.

The authors found the family history of coronary artery disease an imperfect surrogate for genotype-defined risk.

They pointed out that the prevalence of self-reported family history tended to be higher among participants at high genetic risk than among those at low genetic risk.

This makes sense based on high family prevalence rates of heart disease being easier to recollect than low prevalence.  In other words, it's easier to remember if your father suffered a heart attack than if he never did. 

The DNA phenotype was able to demonstrate cardiac risk and its reduction in those following healthier lifestyle patterns.

What is a “Healthy Diet”?

A healthy diet pattern was based on adherence to what was described as a heart-healthy diet as follows:

  • Higher consumption of fruits, nuts, vegetables, whole grains, fish, and dairy products, and
  • Reduced intake of refined grains, processed meats, unprocessed red meats, sugar-sweetened beverages, trans fats (one cohort only), and sodium (one cohort only).

The "healthy diet" patterns defined in this study resemble the Mediterranean diet, though vast improvements could be made to reduce coronary events further.

For instance, the majority of calories you consume should come from fruits, nuts, fish, whole grains, legumes, and other plant foods.

And limited amounts of your diet should be processed meats, unprocessed red meats, refined grains, and sugar-sweetened beverages. (Refer to box on page x to view a list of toxic foods to avoid.)

Diet patterns in this study were assessed by food-frequency questionnaires that can have high error rates. That's because people do not always have a strong recall of their real-world food and beverage intake.

These factors might explain why a "healthy diet" reduced the rate of coronary artery disease by only 9% whereas greater reductions occurred in high genetic risk people who avoided smoking and obesity and engaged in regular physical activity. (It's easy to identify smoking and obesity compared to data obtained from food-questionnaires.)

The authors of this study concluded that:

"After quantifying both genetic and lifestyle risk among 55,685 participants in three prospective cohorts and one cross-sectional study, we found that adherence to a healthy lifestyle was associated with a substantially reduced risk of coronary artery disease within each category of genetic risk."1

More Should be Done!

We at Life Extension advocated decades ago for more aggressive interventions to prevent and treat atherosclerosis.

In addition to heart attack and ischemic stroke, arterial/vascular diseases also contribute to:

  • Several types of Dementia5-7
  • Peripheral arterial disease8-10
  • Heart failure10-12
  • Renal artery stenosis8,13,14
  • Carotid artery stenosis and embolization15
  • Kidney failure16
  • Hypertension17
  • Aortic calcification18,19
  • Mesenteric artery disease20
  • Erectile dysfunction21-23
  • Frailty24,25
  • Accelerated aging18

Family history of cardiovascular disease is a known risk factor. There are, however, specific genetic influences, such as lipid and glucose imbalances that can be reversed if caught in time.

Food to Reduce or Avoid26

  • Red Meat
  • Overcooked Meats
  • Butter
  • Processed Red Meat (Hot Dogs, Bacon)
  • Cured Ham (Nitrite/Nitrite-Preserved Meats)
  • Most Frozen Meals
  • Soda, Desserts, Candy
  • Most Processed Foods
  • Sugars
  • Refined Grains (White Bread/White Grain Pasta)
  • Excess Salt

Diagnostic Tests Enable Early Detection

Blood tests identify risk factors that are correctable before a catastrophic event strikes.

The panel on the next page measures common atherosclerotic biomarkers including glucose, fasting insulin and A1C.

In people with early-stage insulin resistance, high fasting insulin can suppress glucose and A1C, thus masking a smoldering type II diabetic disorder. Serious tissue damage occurs during this prediabetic stage.

The time to reduce elevated glucose + A1C + fasting insulin is before full blown type II diabetes strikes.

And the period to control other damaging risk factors is before one suffers a heart attack or ischemic stroke.

No one interested in healthy longevity should tolerate hypertension. Effective medications are widely available to lower blood pressure.

The New England Journal of Medicine published study showed that those at high genetic risk for cardiovascular disease attain significant protection by following favorable lifestyles.

Even greater benefits can be achieved by controlling risk factors that are easily detectable with diagnostic testing.

Many of you purchased our comprehensive Male or Female Blood Test Panel earlier this year. If any vascular pathologies were detected, you should re-test your blood for these specific atherosclerotic factors after initiating corrective actions.

Be it lifestyle changes or new medications, you want to check and see if you are moving your cardiovascular health measures (like lipid and glycemic markers) into safer, cardio-protective ranges.

Please note that all blood tests are offered at extra-discounted prices until July 8, 2024.

For longer life,

For Longer Life

William Faloon, Co-Founder
Life Extension®


  1. Khera AV, Emdin CA, Drake I, et al. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. N Engl J Med. 2016 Dec 15;375(24):2349-58.
  2. van Holten TC, Waanders LF, de Groot PG, et al. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One. 2013;8(4):e62080.
  3. Available at: Accessed May, 4, 2023.
  4. Said MA, van de Vegte YJ, Zafar MM, et al. Contributions of Interactions Between Lifestyle and Genetics on Coronary Artery Disease Risk. Curr Cardiol Rep. 2019 Jul 27;21(9):89.
  5. Gottesman RF, Albert MS, Alonso A, et al. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 Oct 1;74(10):1246-54.
  6. Cederwald BFv, Josefsson M, Wåhlin A, et al. Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia. Neurology. 2022;98(20):e2013-e22.
  7. Available at: Accessed May, 8, 2023.
  8. Imori Y, Akasaka T, Ochiai T, et al. Co-existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral arterial disease in patients with coronary artery disease. Am J Cardiol. 2014 Jan 1;113(1):30-5.
  9. Available at: Accessed March 6, 2024.
  10. Samsky MD, Hellkamp A, Hiatt WR, et al. Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID. J Am Heart Assoc. 2021 Jun 15;10(12):e018684.
  11. Duprez DA. Arterial stiffness/elasticity in the contribution to progression of heart failure. Heart Fail Clin. 2012 Jan;8(1):135-41.
  12. Available at: Accessed May, 5, 2023.
  13. Lao D, Parasher PS, Cho KC, Yeghiazarians Y. Atherosclerotic renal artery stenosis--diagnosis and treatment. Mayo Clin Proc. 2011Jul;86(7):649-57.
  14. Bokhari MR, Bokhari SRA. Renal Artery Stenosis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
  15. Available at: Accessed March 6, 2024.
  16. Available at: Accessed March 6, 2024.
  17. Weber T, Lang I, Zweiker R, et al. Hypertension and coronary artery disease: epidemiology, physiology, effects of treatment, and recommendations : A joint scientific statement from the Austrian Society of Cardiology and the Austrian Society of Hypertension. Wien Klin Wochenschr. 2016 Jul;128(13-14):467-79.
  18. Hata Y, Mochizuki J, Okamoto S, et al. Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study. Medicine (Baltimore). 2022 Jul 22;101(29):e29875.
  19. Kälsch H, Lehmann N, Moebus S, et al. Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis. Journal of the American Heart Association. 2017;6(4):e005093.
  20. Krishnamurthy G, Menon A, Kannan K, et al. Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis. Intractable Rare Dis Res. 2019 Nov;8(4):245-51.
  21. Kumagai H, Yoshikawa T, Myoenzono K, et al. Sexual Function Is an Indicator of Central Arterial Stiffness and Arterial Stiffness Gradient in Japanese Adult Men. J Am Heart Assoc. 2018 May 5;7(10).
  22. Assar ME, Angulo J, Garcia-Rojo E, et al. Early manifestation of aging-related vascular dysfunction in human penile vasculature-A potential explanation for the role of erectile dysfunction as a harbinger of systemic vascular disease. Geroscience. 2022 Feb;44(1):485-501.
  23. Meller SM, Stilp E, Walker CN, Mena-Hurtado C. The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. J Invasive Cardiol. 2013 Jun;25(6):313-9.
  24. Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J. 2014 Jul;35(26):1726-31.
  25. Liperoti R, Vetrano DL, Palmer K, et al. Association between frailty and ischemic heart disease: a systematic review and meta-analysis. BMC Geriatr. 2021 Jun 10;21(1):357.
  26. Available at: Accessed March 6, 2024.