Evidence map›Paper›PMID 25572509›Full record

Observational studyJournal of the American College of Cardiology2015

Healthy lifestyle in the primordial prevention of cardiovascular disease among young women.

Andrea K Chomistek, Stephanie E Chiuve, A Heather Eliassen, Kenneth J Mukamal, Walter C Willett, Eric B Rimm

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American College of Cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
121citing papers in PubMed, 7 pooled it
20.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

121 citing papers in PubMed, 7 syntheses or guidelines pooled it, 279 citations in OpenAlex.

  1. Pooled it
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  7. Guideline
  8. Diet Quality and Physical Activity at 3-4 Years Following a Hypertensive Pregnancy: A Blood Pressure Postpartum Cross-Sectional Sub-Study.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026
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  14. Modeling the Impact of Behavior Changes on Mortality Attributable to Non-communicable Diseases in Canada.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2026
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61 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Andrea K ChomistekDepartment of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana. Electronic address: achomist@indiana.edu.
Stephanie E ChiuveDepartment of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
A Heather EliassenChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Kenneth J MukamalDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Walter C WillettDepartment of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Eric B RimmDepartment of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Brigham and Women's Hospital · USBeth Israel Deaconess Medical Center · USIndiana University Bloomington · US

Funding

Risk Factors for Breast Cancer in Younger NursesR01CA050385 · NCI · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI ELIASSEN, A. HEATHER, WILLETT, WALTER C. · 1989 to 2019
$32.3M
Life Course Cancer Epidemiology Cohort in WomenUM1CA176726 · NCI · HARVARD SCHOOL OF PUBLIC HEALTH · PI WILLETT, WALTER C. · 2013 to 2017
$15.7M
TRAINING GRANT IN ACADEMIC NUTRITIONT32DK007703 · NIDDK · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI CHRISTOPHER P DUGGAN, Frank B Hu · 1994 to 2026
$7.8M
NCI NIH HHS CA176726NCI NIH HHS R01 CA050385NCI NIH HHS UM1 CA176726NIDDK NIH HHS DK007703NIDDK NIH HHS T32 DK007703
6 · The paper itself

Abstract

backgroundOverall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown.

objectivesThe aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle.

methodsA prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses' Health Study II who were followed from 1991 to 2011. Lifestyle factors were updated repeatedly by questionnaire. A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index-2010, and 0.1 to 14.9 g/day of alcohol. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent.

resultsDuring 20 years of follow-up, we documented 456 incident CHD cases. In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22). Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle.

conclusionsPrimordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD.

Indexed as

Health BehaviorPrimary PreventionAdultCoronary DiseaseFemaleHumansLife StyleMultivariate AnalysisProportional Hazards ModelsProspective StudiesRisk Factorscoronary diseasediabetesepidemiologyhypercholesterolemiahypertensionrisk factors

Identifiers

PMID25572509
PMCPMC4291551
OpenAlexW1974713100

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.