Women who eat a healthy diet, drink moderate amounts of alcohol, are physically active, maintain a healthy weight and do not smoke have a significantly reduced risk of heart attack, according to a new report in the Archives of Internal Medicine.

"Coronary heart disease is the most important cause of death and disability in women," the authors wrote. "Despite a lower incidence in women, coronary heart disease -- related mortality and the percentage of sudden deaths from coronary heart disease without previous symptoms is higher and the trend of decline in incidence is slower than in men."

Agneta Akesson, Ph.D., M.P.H., of the Karolinska Institutet, Stockholm, and colleagues identified dietary patterns in 24,444 postmenopausal women by analyzing food frequency questionnaires, on which the women supplied information about how often they ate 96 common foods.

"We derived four major dietary patterns: 'healthy' (vegetables, fruits and legumes), 'Western' (red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes and fish), 'alcohol' (wine, liquor, beer and some snacks) and 'sweets' (sweet baked goods, candy, chocolate, jam and ice cream)," the authors wrote. Participants also answered questions about education, family history, health status, use of medications, body measurements and physical activity. When they enrolled in the study in 1997, none of the women had heart disease, diabetes or cancer.

Over an average of 6.2 years of follow-up, 308 women had a new myocardial infarction (heart attack); 51 of these cases were fatal. Two diet types -- "healthy" and "alcohol" -- were associated with a reduced risk for heart attack.

"The low-risk diet (high scores for the healthy dietary pattern) characterized by a high intake of vegetables, fruit, whole grains, fish and legumes, in combination with moderate alcohol consumption (5 grams of alcohol per day or less), along with the three low-risk lifestyle behaviors [not smoking, having a waist-hip ratio of less than the 75th percentile and being physically active], was associated with 92 percent decreased risk compared with findings in women without any low-risk diet and lifestyle factors," the authors write. "This combination of healthy behaviors, present in 5 percent, may prevent 77 percent of myocardial infarctions in the study population."

Several components of fruits, vegetables and whole grains -- including fiber, antioxidant vitamins and minerals -- have been associated with a reduced risk for coronary heart disease, the researchers note. In addition, previous studies have found beneficial effects of small amounts of alcohol in preventing the buildup of plaque in the arteries, which could help prevent heart attacks.

"Our study findings indicate that healthy dietary behaviors are present in the population," the authors conclude. "These dietary behaviors together with a healthy lifestyle and body weight mayprevent most myocardial infarction events."

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