Diet, lifestyle, biomarkers, genetic factors, and risk of cardiovascular disease in the nurses' health studies

Objectives. To review the contributions of the Nurses' Health Studies (NHSs) to the understanding of cardiovascular disease etiology in women. Methods.We performed a narrative review of the publications of the NHS and NHS II between 1976 and 2016. Results.Diets lowin trans fat, saturatedfat, refinedcarbohydrates, andsugar-sweetened beverages and rich in fruits and vegetables, whole grains, and sources of unsaturated fats are associatedwith reduced risk of cardiovascular disease. Healthy lifestyle choices include smoking avoidance, regular physical activity, maintaining a normal body mass index, and moderate alcohol consumption. Adherence to a combination of these healthy diet and lifestyle behaviors may prevent most vascular events. Studies also covered oral contraceptive use, postmenopausal hormone therapy, shift work, sleep duration, psychosocial factors, and various biomarkers and genetic factors. Findings, such as the association of trans fat with cardiovascular disease, have helped shaped medical guidelines and government policies. Conclusions. The NHS has provided compelling evidence that the majority of vascular events may be prevented by avoiding smoking, participating in regular physical activity, maintaining normal body mass index, and eating a healthy diet.