WEDNESDAY, July 5 (HealthSCOUT) -- The payoff to preventing heart disease is big for people who follow five rules for reducing lifestyle-related risks, a study finds.

"The unique thing about our study is that it is the first time we made an estimate of what the impact would be if all the recommendations are followed simultaneously," says Dr. Meir J. Stampfer, professor of epidemiology and nutrition at the Harvard School of Public Health, whose group reports its findings in the New England Journal of Medicine. "In our cohort, 82 percent of all heart attacks were attributed to failure to follow all the rules."

Those rules: Don't smoke; stay slim, with a body-mass index under 25; do moderate to vigorous physical exercise for at least 30 minutes a day; eat a diet high in fiber, folate and fish; and have half a drink of alcohol a day.

It might seem hard to do all those things consistently, says Stampfer, but, in fact, the recommendations are interrelated, so that "there is no reason why everybody can't do all five."

The finding comes from looking at data from the Nurses' Health Study, which followed more than 84,000 women for 14 years. There were 1,128 heart attacks in the group over the years. Impressively, the 3 percent of the women who followed all the rules had just 17 percent of the risk of having a heart attack as the other women in the group.

The relationship held true when other risk factors were considered, including age, family history, high blood pressure and menopausal status, the report says.

Stampfer says he doesn't want to single out any one or two of the risk factors as being critical. "If you look at them individually, it's hard to judge," he says.

But Dr. Robert H. Eckel, chairman of the American Heart Association committee on nutrition, says his look at the data indicates that diet appears to play a role second only to the no-smoking recommendation.

"I'm pleased to see that if you break it down, diet is perhaps the second-most important element," Eckel says, quickly adding that the study indicates "encouraging women to modify just one aspect of their lifestyle may not be sufficient."

While the specific dietary recommendations of the Harvard group differ slightly from the current recommendations of the American Heart Association, "our position is not that much different," says Eckel, who is professor of medicine at the University of Colorado Health Sciences Center.

The association will issue revised dietary guidelines in the next few weeks, he says, and they will be "consistent with almost all their recommendations."

The one risk factor recommendation that might stir some controversy concerns alcohol intake, Eckel says. While many studies have shown that a moderate intake of alcohol can reduce coronary risk, "there is concern whether the recommendations should be made for the public at large," he says. "It should be individually considered."

Overall, he says, the study confirms the value of the existing recommendations for cardiovascular health: "My feeling is one of satisfaction that cardiovascular risk is what we think it to be."

What To Do

Get off of the couch, start exercising, put out the cigarette, ditch the candy bars and start looking critically at your diet. But talk to a doctor before any sudden change in how you live.

If you're wondering what's in the food you're eating, the U.S. Department of Agriculture has put together an amazing Interactive Healthy Eating Index that will tell you not just calories, but how much carbohydrate, protein, vitamins (including folate) and much more you're taking in. This site requires you to fill in a user name, but it just takes a second. Here's the Food Guide Pyramid and also what the American Heart Association recommends. Wondering what your BMI is? Fill in the blanks here and find out.

(From HealthSCOUT )