The role of lifestyle changes for primary prevention of heart attack or other cardiovascular diseases cannot be undermined. Small lifestyle changes, over a period, can make a lot of difference and pay rich dividends when it comes to heart health. In line with this hypothesis, people who spend less time watching TV and regularly eat a healthy breakfast may have a lower risk of developing heart disease or suffering a stroke, a new study suggests.
This new two-part study is being presented at the American College of Cardiology’s 68th Annual Scientific Session on 16th March. The study found that those who watched TV for less time and ate a healthy breakfast showed significantly less plaque and stiffness in their arteries. These observations emphasise the benefits of lifestyles that incorporate balanced eating and less sedentary time.
“Environmental and lifestyle factors are important but underestimated risk factors for cardiovascular disease,” said Dr Sotirios Tsalamandris, a cardiologist at the National and Kapodistrian University of Athens (Greece). He added that the study emphasises the many factors that impact heart disease and the need for holistic preventive approaches.
Researchers assessed markers of heart health, along with a variety of environmental exposures and lifestyle factors, in 2,000 people living in Corinthia (Greece). Participants ranged from the ages of 40 to 99 years, with an average age of 63 years, and represented a broad spectrum of the general population. The group included healthy people as well as those with cardiovascular risk factors and established heart disease.
Detailed questionnaires were used to assess participants’ physical activity levels and eating habits, while two non-invasive tests were used to assess the condition of participants’ arteries. The first test, carotid femoral pulse wave velocity, measured the speed of pressure waves that move along the arteries to detect stiffening of the arteries or atherosclerosis. The second test used ultrasound imaging to measure the thickness of the inner part of the arterial wall. Thickening of the arterial walls reflects plaque build-up and is associated with an increased risk of stroke.
In the first segment of the study, researchers divided participants into three groups according to the number of hours spent watching television or videos each week: a low amount (seven hours or fewer), a moderate amount (seven to 21 hours) or a high amount (more than 21 hours). After accounting for cardiovascular risk factors and heart disease status, researchers found those watching the most TV per week were almost twice as likely to have plaque build-up in the arteries compared with those watching the least.
“Our results emphasize the importance of avoiding prolonged periods of sedentary behaviour,” Dr Tsalamandris said. “These findings suggest a clear message to hit the off button on your TV and abandon your sofa. Even activities of low energy expenditure, such as socialising with friends or housekeeping activities, may have a substantial benefit to your health compared to time spent sitting and watching TV.”
Researchers also concluded that watching more TV was associated with an increased risk of other cardiovascular risk factors, including high blood pressure and diabetes. Compared to those watching less than seven hours of TV per week, those watching more than 21 hours per week were 68% more likely to have high blood pressure and 50% more likely to have diabetes.
In the second part of the study, participants were divided into three groups based on how much of their daily caloric intake came from breakfast: high-energy (breakfast contributing more than 20% of daily calories), low-energy (5%-20% of daily calories) or skipped breakfast (less than 5% of daily calories). In total, about 240 people reported a high-energy breakfast; nearly 900 ate a low-energy breakfast; and about 680 skipped breakfast.
Breakfast foods commonly eaten by those in the high-energy group included milk, cheese, cereals, bread and honey. Breakfast for those in the low-energy group, typically, included coffee or low-fat milk along with bread & butter, honey, olives or fruit. Researchers found that those who ate a high-energy breakfast tended to have significantly healthier arteries than those who ate little or no breakfast. Even after accounting for cardiovascular risk factors, pulse wave velocity as well as arterial thickness were, on average, highest in those skipping breakfast and lowest in those eating a high-energy breakfast.
“A high-energy breakfast should be part of a healthy lifestyle,” Dr. Tsalamandris said. “Eating a breakfast constituting more than 20% of the total caloric intake may be of equal or even greater importance than a person’s specific dietary pattern, such as whether they follow the Mediterranean diet, a low-fat diet or other dietary pattern.”
However, Dr Tsalamandris also indicated that because most study participants followed a Mediterranean diet overall, it is unknown how the findings translate for people following different dietary patterns.
It is important to note that this research was strictly observational and that the study does not prove cause & effect. The reason for the association between a high-energy breakfast and better heart health is unclear. However researchers have offered two possible explanations, based on previous studies. One is that people who eat breakfast tend to eat healthier food overall and have fewer unhealthy lifestyle patterns such as smoking and sedentary behaviour than those who skip breakfast. Another is that the specific breakfast foods consumed in the high-energy group, such as dairy products, may benefit heart health. The research team plans to continue tracking health outcomes in the participants for at least 10 years, with a primary focus on assessing potential impact of environmental exposures.