Two studies published last month add to the vast amount of evidence on the positive effect that lifestyle choices have on disease risk. Tangney and colleagues showed that eating a Mediterranean diet or a DASH diet were each associated with less cognitive decline in elderly individuals.¹ This was equivalent to reducing cognitive age by 4.4 years. Akesson and colleagues showed that men who practiced five healthy behaviors had a 79% risk reduction for myocardial infarction compared with all other men in the study.² The number increased to an 86% reduction when men who practiced all five behaviors were compared with those who did not practice any.

Let’s look at some other large studies showing similar results when individuals who practiced four healthy behaviors were compared with those who did not. The behaviors were: no smoking; exercise; healthy diet; limited alcohol.

• The Nurses’ Health Study (N = 84,129) found an 83% reduction in coronary events.

• The Health Professionals Follow-Up Study (N = 42,847) found an 87% reduction in coronary artery disease.

• The Women’s Health Study (N = 37,636) found a 71% reduction in stroke.

• The EPIC-Norfolk Study (N = 20,244) found an additional 14 years of life.

An ironic limitation of Akesson’s study was that, of the 20,721 men followed, there were 1361 heart attacks, but only 3 in those participants who met all five low-risk behaviors, making the power suspect. In addition, only 1% of the study population engaged in all five behaviors. However, despite only three heart attacks in this 1%, the data were statistically significant.

When we can’t find enough disease for statistical significance in those who practice the healthiest lifestyles, it is a good sign! On the other hand, the researchers could only find 1% of the study population who engaged in all five healthy behaviors.

If we want to influence health outcomes based on strong (some might say burly!) evidence, we need to get better at changing things, not just giving things (medication, advice). This is where the potential of interdisciplinary primary care teams that address the health needs of a community is greatest.