Guess what? Instead of babying our backs, we may have to be sure to get plenty of running, jogging, or brisk walking to make our backs stronger - specifically, to strengthen the discs in our spines. Once again, a study finds that exercise (here the upright exercise of running, jogging, or fast walking) has benefits. The authors of the study state that the research results go against conventional medical wisdom - that instead of weakening the spine (conventional view), those people who run or jog  many miles each week may actually be strengthening the discs of the spine. And maybe... the researchers suggest (though it needs to be verified first)... in the future, we may get medical prescriptions to jog or fast walk a certain number of miles each week to strengthen the discs in our spines.

The study found that the ideal speed for the spine health was a slow run or a fast walk (4 miles per hour). Specifically fast walking and slow running at about 2 meters per second (m/s) appeared the most beneficial. However, high impact exercises, or aerobic exercises, slower walking, or no exercise did not have these benefits.

Until now, discs had been considered a "slow tissue," thought to take much longer to respond to exercise than muscle. And that with age and use the discs degenerate, and nothing could really be done to improve them. But the study's findings suggest that exercise can benefit and strengthen the intervertebral disc (IVD) in the spine. As researcher Dr. Belavy said: "It's also important to reduce the amount of time spent in static postures, such as sitting or even standing still. Even going for a walk during a break at work, or choosing to take the stairs rather than the elevator is good for the discs, as well as for overall back health."

From NY Times: Why Running May Be Good for Your Back

People who regularly run or walk briskly appear to have healthier discs in their spines than people who do not exercise, according to one of the first studies to closely examine links between movement and disc health. The findings refute a widely held belief that activities like running might overtax the spine and indicate that, instead, they make it sturdierThe human spine is a complicated mechanism, composed of vertebral bones cushioned between intervertebral discs. These discs, shaped like tiny whoopee cushions, contain a viscous fluid that compresses and absorbs pressure during movement, keeping the back in good working form. With age, disease or injury, spinal discs can degenerate and bulge, resulting in back pain, which can be debilitating.

There were tantalizing hints in animal studies, however, that this idea could be out of date. ....So for the new study, which was published in April in Scientific Reports, researchers at Deakin University in Australia and other institutions decided to examine the backs of people who run and others who do not. Eventually they recruited 79 adult men and women, two-thirds of whom said that they were runners. Some of these told the researchers that they covered more than 30 miles (about 50 kilometers) a week in training. The researchers designated these as the “long-distance” group. The others said that they ran between 12 and 25 miles a week. All had been training for at least five years. The final group rarely exercised at all.

To ensure that people’s reported activity levels were accurate, the researchers asked their volunteers to wear accelerometers for a week. Then they scanned everyone’s spines, using a sophisticated type of M.R.I. that precisely measures the size and liquidity of each disc. And they found differences. In general, the runners’ discs were larger and contained more fluid than the discs of the men and women who did not exerciseSince both greater size and increased levels of internal fluid indicate better disc health, the runners harbored fundamentally healthier spines than the people who were sedentary, says Daniel Belavy, a professor of physical activity at Deakin University who led the study. Interestingly, mileage barely mattered

 Once again a great reason to exercise - a study found that adults with the highest levels of weekly physical activity had the longest telomeres, which are markers of overall health and aging. Think of it this way: we all age, but some people seem young for their age, while others seem old for their age. This study looked at differences among groups of people at the cellular level.

The multi-year study looked at both physical activity levels of 5,823 adults and their telomeres. The adults provided DNA samples, from which the researchers measured telomere length. Telomeres are "protein caps positioned at the end of chromosomes". Aging causes telomeres to shorten and results in gradual cell deterioration - thus they are good markers of our biological age, that is, how we're aging (rather than just our chronological age). Study author Larry A. Tucker said “We know that, in general, people with shorter telomeres die sooner and are more likely to develop many of our chronic diseases. It's not perfect, but it's a very good index of biological aging.”

What causes telomeres to shrink faster?  Telomere shortening  can be hastened by things that result in inflammation and oxidative stress, such as obesity, smoking, poor diet, type 2 diabetes, and low socioeconomic levels. On the other hand, this study found that adults with high levels of physical activity had significantly longer telomeres. The longer telomeres found in the active adults reduced cellular aging by about 9 years, as compared to those adults who were sedentary or had low to medium levels of physical activity. Nine years less of biological aging is a lot! The shortest telomeres were in sedentary people.

How much physical activity should one aim for? The study found that activity levels in the study were measured in MET-minutes (metabolic equivalent minutes) - which can sound confusing, but can be achieved by incorporating exercise into daily routines, as well as also doing vigorous activities or exercises. In the present study, men had to attain >1887 MET-minutes per week and women >1375 to be included in the category with the highest activity levels (longest telomeres). It does mean several hours a week of physical activity, which can include gardening, bicycling, walking, vacuuming, exercising, running, etc. From Science Daily:

High levels of exercise linked to nine years of less aging at the cellular level

Despite their best efforts, no scientist has ever come close to stopping humans from aging. But new research from Brigham Young University reveals you may be able to slow one type of aging -- the kind that happens inside your cells. As long as you're willing to sweat. "Just because you're 40, doesn't mean you're 40 years old biologically," Tucker said. "We all know people that seem younger than their actual age. The more physically active we are, the less biological aging takes place in our bodies."

The study, published in the medical journal Preventive Medicine, finds that people who have consistently high levels of physical activity have significantly longer telomeres than those who have sedentary lifestyles, as well as those who are moderately activeTelomeres are the protein endcaps of our chromosomes. They're like our biological clock and they're extremely correlated with age; each time a cell replicates, we lose a tiny bit of the endcaps. Therefore, the older we get, the shorter our telomeres.

Exercise science professor Larry Tucker found adults with high physical activity levels have telomeres with a biological aging advantage of nine years over those who are sedentary, and a seven-year advantage compared to those who are moderately active. To be highly active, women had to engage in 30 minutes of jogging per day (40 minutes for men), five days a week.

Tucker analyzed data from 5,823 adults who participated in the CDC's National Health and Nutrition Examination Survey, one of the few indexes that includes telomere length values for study subjects....His study found the shortest telomeres came from sedentary people -- they had 140 base pairs of DNA less at the end of their telomeres than highly active folks. Surprisingly, he also found there was no significant difference in telomere length between those with low or moderate physical activity and the sedentary people.

 An interesting study looked at what the act of walking does to our brain, and found that it can modify and increase the amount of blood that’s sent to the brain (which is viewed as beneficial for brain function). The study, performed by researchers at New Mexico Highlands University in the United States, found that the foot’s impact on the ground while walking sends pressure waves through the arteries, which can increase the blood supply to the brain. This is referred to as cerebral blood flow or CBF.

These results may help explain other studies that find those that walk frequently (about 6 to 9 miles per week) have "less cognitive impairment" or cognitive decline, fewer memory problems, and greater brain volume with aging.  Another good reason to get out and walk - good for the heart, the body, and the brain. From Science Daily:

How walking benefits the brain

You probably know that walking does your body good, but it's not just your heart and muscles that benefit. Researchers at New Mexico Highlands University (NMHU) found that the foot's impact during walking sends pressure waves through the arteries that significantly modify and can increase the supply of blood to the brain. The research will be presented today at the APS annual meeting at Experimental Biology 2017 in Chicago.

Until recently, the blood supply to the brain (cerebral blood flow or CBF) was thought to be involuntarily regulated by the body and relatively unaffected by changes in the blood pressure caused by exercise or exertion. The NMHU research team and others previously found that the foot's impact during running (4-5 G-forces) caused significant impact-related retrograde (backward-flowing) waves through the arteries that sync with the heart rate and stride rate to dynamically regulate blood circulation to the brain.

In the current study, the research team used non-invasive ultrasound to measure internal carotid artery blood velocity waves and arterial diameters to calculate hemispheric CBF to both sides of the brain of 12 healthy young adults during standing upright rest and steady walking (1 meter/second). The researchers found that though there is lighter foot impact associated with walking compared with running, walking still produces larger pressure waves in the body that significantly increase blood flow to the brain. While the effects of walking on CBF were less dramatic than those caused by running, they were greater than the effects seen during cycling, which involves no foot impact at all.

 A possible problem with running marathons is short term kidney injury in the two days right after the race. A study of 22 runners in the 2015 Hartford (Connecticut) Marathon found that most of the runners temporarily developed acute kidney injury (AKI) directly after the race. The study main author Chirag R. Parikh, MD, PhD said: "The kidney responds to the physical stress of marathon running as if it's injured, in a way that's similar to what happens in hospitalized patients when the kidney is affected by medical and surgical complications".

The runners studied fully recovered from the kidney injury 2 days after the event, but the study raises questions about the long-term effects for regular marathon runners, especially in warmer climates. Also, how about the effects of repeated marathons? The researchers say they can only speculate that marathoners adapt to the kidney injury, because they recover within 2 days. But they also pointed out that research has shown there are also changes in heart function associated with marathon running. Something else to keep in mind when considering training for marathons. From Science Daily:

Marathon running may cause short-term kidney injury

According to a new Yale-led study, the physical stress of running a marathon can cause short-term kidney injury. Although kidneys of the examined runners fully recovered within two days post-marathon, the study raises questions concerning potential long-term impacts of this strenuous activity at a time when marathons are increasing in popularity. More than a half million people participated in marathons in the United States in 2015.

While past research has shown that engaging in unusually vigorous activities -- such as mine work, harvesting sugarcane, and military training -- in warm climates can damage the kidneys, little is known about the effects of marathon running on kidney health. A team of researchers led by Professor of Medicine Chirag Parikh, M.D. studied a small group of participants in the 2015 Hartford Marathon. The team collected blood and urine samples before and after the 26.2-mile event. They analyzed a variety of markers of kidney injury, including serum creatinine levels, kidney cells on microscopy, and proteins in urine.

The researchers found that 82% of the runners that were studied showed Stage 1 Acute Kidney Injury (AKI) soon after the race. AKI is a condition in which the kidneys fail to filter waste from the blood. "The kidney responds to the physical stress of marathon running as if it's injured, in a way that's similar to what happens in hospitalized patients when the kidney is affected by medical and surgical complications," said Parikh. The researchers stated that potential causes of the marathon-related kidney damage could be the sustained rise in core body temperature, dehydration, or decreased blood flow to the kidneys that occur during a marathon. [Original study.]

 A new study found differences in gut microbes between active women (they exercised at least the recommended amount) and those that are sedentary. When the gut bacteria were analyzed with modern tests (genetic sequencing) the active women had more of the health promoting beneficial bacteria such as Faecalibacterium prausnitzii, Roseburia hominis, and Akkermansia muciniphila than the sedentary women. The sedentary women also had some bacterial species not seen in the active women. The researchers said that exercise "modifies the composition of gut microbiota" (the gut microbes) in a way beneficial for health.

And what is the recommended minimal amount of exercise? The World Health Organization recommends at least 3 days of exercise per week for 30 minutes at a moderate intensity. Note that exercise can mean doing exercises, but it can also include walking briskly, intense housework (scrubbing, vacuuming with lots of bending, etc.), gardening (digging, raking, etc), or shoveling snow, etc. In this study the group of active women had at least 3 hours of physical exercise per week. Note that a sedentary lifestyle is associated with a high incidence of chronic diseases such as cardiovascular disease, cancer and diabetes, while physical exercise or activity has metabolic and immune health benefits (prevents disease).

But...reading the full study, the research also showed that the active group ate more fruits and vegetables - which we know has an effect on the gut microbiome and feeds beneficial bacteria. Although the diets of the 2 groups of women were similar in total carbohydrates, protein and fat content eaten, the active women ate more fruits, vegetables, and fiber, and the sedentary group ate more processed meat. So it looks like both exercise and a good amount of fruits and vegetables may be important for nurturing beneficial bacteria. By the way, the 3 species of beneficial bacteria mentioned currently are not found in any probiotic supplements on the market. (Earlier posts on the beneficial F. prausnitzii and Akkermansia muciniphila). From PLoS ONE:

Differences in gut microbiota profile between women with active lifestyle and sedentary women

Physical exercise is a tool to prevent and treat some of the chronic diseases affecting the world’s population. A mechanism through which exercise could exert beneficial effects in the body is by provoking alterations to the gut microbiota, an environmental factor that in recent years has been associated with numerous chronic diseases. Here we show that physical exercise performed by women to at least the degree recommended by the World Health Organization can modify the composition of gut microbiota. Using high-throughput sequencing of the 16s rRNA gene, eleven genera were found to be significantly different between active and sedentary women. Quantitative PCR analysis revealed higher abundance of health-promoting bacterial species in active women, including Faecalibacterium prausnitzii, Roseburia hominis and Akkermansia muciniphila. Moreover, body fat percentage, muscular mass and physical activity significantly correlated with several bacterial populations. In summary, we provide the first demonstration of interdependence between some bacterial genera and sedentary behavior parameters, and show that not only does the dose and type of exercise influence the composition of gut microbiota, but also the breaking of sedentary behavior.

Sedentary lifestyle is associated with a high incidence of chronic diseases such as cardiovascular disease, cancer and diabetes. Physical exercise is a powerful preventative and treatment intervention that is known to be effective in generating metabolic and immune health benefits. The gut microbiota is essential for processing dietary components and has a major role in shaping the immune system.... Dysbiosis or imbalance in gut microbiota has been associated with many diseases, among which are ulcerative colitis, Crohn's disease, colon cancer, metabolic syndrome, type I and type II diabetes, cardiovascular disease, allergy, asthma, eczema and autism.....Several studies in experimental models have addressed the relationship between gut microbiota composition and physical exercise....Collectively, these findings indicate that modulation of the microbiota by exercise depends not only on the physiological state of the individual, but also on the diet.

A total of 15 phyla were detected, in order of presence: Bacteroidetes (54%), Firmicutes (44%), Proteobacteria (0.96%), Tenericutes (0.39%), Verrucomicrobia (0.11%), Euryarchaeota (0.08%), Actinobacteria (0.07%), Lentisphaerae (0.06%), Cyanobacteria (0.050%), Spirochaetes (0.04%), Fusobacteria (0.014%), Elusimicrobia (0.009%), Synergistetes (0.007%), kTM7 (0.003%), and Acidobacteria (0.0001%). Acidobacteria (2 subjects), Elusimicrobia (2 subjects) and Spirochaetes (2 subjects) phyla were detected only in sedentary subjects.... At the genus level, there were significant differences in eleven genera: Bifidobacterium, Barnesiellaceae, Odoribacter, Paraprevotella, Turicibacter, Clostridiales, Coprococcus, Ruminococcus, and two unknown genera of Ruminococcaceae family. Given the importance of some bacterial species in health, the presence of Bifidobacterium longum, Faecalibacterium prausnitzii, Roseburia hominis, Akkermansia muciniphila was measured by qPCR. Analyses revealed a more significant abundance of F. prautznnii, R. hominis and A. muciniphila in active than in sedentary women.

Among all the genera studied, the abundance of eleven of them was significantly different between the active and sedentary group, with Paraprevotella and an unclassified genus of the Desulfovibrionaceae family specifically associated with sedentarism parameters, while the remaining genera where largely associated with diet parameters.....Nonetheless, as exercise and diet often go hand in hand, an active lifestyle is frequently associated with a high consumption of fruits and vegetables, whereas sedentarism is associated with the consumption of high-calorie and fatty foods. Indeed, exercise interventions in human populations have resulted in an improvement in diet habits. Although the diets were similar in our study regarding total carbohydrates, protein and fat content, significant differences were observed for fiber (higher in the active group) and processed meat (higher in the sedentary group).

 Once again, research supports that you should get off your butt and exercise! Or do a moderate to vigorous physical activity at least several times a week, which can include housework, gardening, dancing, swimming, or walking briskly. Most important is to MOVE. And why is this so important? Not just for physical health and prevention of certain diseases, but also for the health of your brain, especially as it ages.

The research looked at both 31 young healthy adults (18 to 31 years old) and 26 older healthy adults (55 to 74 years old), assessed their cardiorespiratory (heart/lung) fitness on the treadmill, gave them a number of neurological tests, and also a memory task while their brain activity was observed during functional Magnetic Resonance Imaging (fMRI). They found that the older adults with higher heart/lung fitness had better performance on the memory task and greater brain activity in multiple regions than the older adults with low heart/lung fitness. The increased brain activity in those with higher levels of heart/lung fitness occurred in brain regions typically affected by age-related decline - in other words, higher fitness in older adults reduced some age-related differences.

The researchers thought these and other study results indicate that heart/lung fitness (cardiorespiratory fitness) may keep the brain younger (that is, it preserves neurological function and "neuroplasticity") as people age. They pointed out that some recent studies have revealed that lower cardiorespiratory (heart/lung) fitness was associated with accelerated cognitive decline and that older adults with lower heart/lung fitness had an increased risk for dementia.

From Health Day: Fitter Seniors May Have Healthier Brains

Good heart and lung fitness can benefit older adults' brains, researchers report.They assessed the heart/lung fitness of healthy young adults (aged 18 to 31) and older adults (aged 55 to 74), and compared their ability to learn and remember the names of strangers in photos. MRI scans recorded images of their brain activity as they learned the names.

The older adults had more difficulty with the memory test than the young adults. But older adults with high levels of heart/lung fitness did better on the test and showed more brain activity when learning new names than those of their peers with lower levels of heart/lung fitness. The increased brain activity in those with higher levels of heart/lung fitness occurred in regions typically affected by age-related decline. The findings suggest that heart/lung fitness may also help keep the brain healthy as people get older, according to the researchers. But the study did not prove a cause-and-effect link.

"Importantly, [heart/lung fitness] is a modifiable health factor that can be improved through regular engagement in moderate to vigorous sustained physical activity such as walking, jogging, swimming or dancing," said study corresponding author Scott Hayes....The researchers said high levels of fitness will not prevent brain decline, but may slow it.

An excerpt from the original study, from Cortex: FMRI activity during associative encoding is correlated with cardiorespiratory fitness and source memory performance in older adults

For brain regions in which older adults showed reduced activation relative to young adults, including left inferior frontal gyrus, medial frontal gyrus, bilateral thalamus, and fusiform gyrus, we observed a step-wise pattern, with the greatest activation in young adults, followed by high CRF [cardiorespiratory fitness] older adults and then low CRF older adults, indicating that higher fitness in older adults reduced age-related differences. These findings suggest that CRF supports successful brain maintenance in aging, in that it promotes the preservation of neural function seen in young adults (Nyberg, Lovden et al., 2012). 

 Worried about whether being physically active just on weekends can make a difference in health if the rest of the week is spent sitting all day? Well, there is good news! Being a "weekend warrior" (one who exercises or is active only one or two days a week) may also offer health benefits according to a new study (associated with lower death rates from all causes, cancer, and cardiovascular disease).

Current government guidelines recommend at least 150 minutes per week of moderate-intensity activity (such as brisk walking or tennis), or at least 75 minutes per week of vigorous activity (such as jogging or swimming laps), or equivalent combinations of moderate and vigorous physical activity. From Science Daily:

'Weekend warriors' have lower risk of death from cancer, cardiovascular disease

Physical activity patterns characterized by just one or two sessions a week may be enough to reduce deaths in men and women from all causes, cardiovascular disease (CVD) and cancer, regardless of adherence to physical activity guidelines, a new study of over 63,000 adults reports. The finding suggests that less frequent bouts of activity, which might fit more easily into a busy lifestyle, offer significant health benefits, even in the obese and those with medical risk factors.

Regular physical activity is associated with lower risks of death from all causes, cardiovascular disease and cancer, and has long been recommended to control weight, cholesterol, and blood pressure. The World Health Organization recommends that adults do at least 150 minutes per week of moderate-intensity activity, or at least 75 minutes per week of vigorous-intensity activity, or equivalent combinations.

But research is yet to establish how the frequency and total weekly dose of activity might best be combined to achieve health benefits. For example, individuals could meet current guidelines by doing 30 minutes of moderate-intensity physical activity five days of the week or 75 minutes of vigorous-intensity physical activity on just one day of the week. Those who do all their exercise on one or two days of the week are known as 'weekend warriors'. 

 Looks like exercise, even 20 minutes of moderate activity such as brisk walking, has beneficial anti-inflammatory health effects. Inflammation is part of the body's normal immune response - it is the body's attempt to heal itself after an injury and tissue damage, and to defend itself against infection from foreign invaders, such as viruses and bacteria. However, chronic inflammation (e.g., what can occur in obesity, diabetes, and poor lifestyle) can lead to serious health issues and is linked to cancer, heart disease, etc. So lowering chronic (systemic) inflammation is good. From Science Daily:

Exercise ... It does a body good: 20 minutes can act as anti-inflammatory

It's well known that regular physical activity has health benefits, including weight control, strengthening the heart, bones and muscles and reducing the risk of certain diseases. Recently, researchers at University of California San Diego School of Medicine found how just one session of moderate exercise can also act as an anti-inflammatory. The findings have encouraging implications for chronic diseases like arthritis, fibromyalgia and for more pervasive conditions, such as obesity.

The study, recently published online in Brain, Behavior and Immunity, found one 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response. The brain and sympathetic nervous system -- a pathway that serves to accelerate heart rate and raise blood pressure, among other things -- are activated during exercise to enable the body to carry out work. Hormones, such as epinephrine and norepinephrine, are released into the blood stream and trigger adrenergic receptors, which immune cells possess. This activation process during exercise produces immunological responses, which include the production of many cytokines, or proteins, one of which is TNF -- a key regulator of local and systemic inflammation that also helps boost immune responses.

The 47 study participants walked on a treadmill at an intensity level that was adjusted based on their fitness level. Blood was collected before and immediately after the 20 minute exercise challenge."Our study shows a workout session doesn't actually have to be intense to have anti-inflammatory effects. Twenty minutes to half-an-hour of moderate exercise, including fast walking, appears to be sufficient," said Hong.

Inflammation is a vital part of the body's immune response. It is the body's attempt to heal itself after an injury; defend itself against foreign invaders, such as viruses and bacteria; and repair damaged tissue. However, chronic inflammation can lead to serious health issues associated with diabetes, celiac disease, obesity and other conditions.

  The wonderful blog posts of Dr. John Mandrola (physician, blogger, and columnist at Medscape) are always thoughtful, and this latest points out things a number of studies have pointed out for a while. Which is to stop obsessing or focusing on "preventive tests" and screenings and numbers, and instead focus on a healthy lifestyle - which means getting regular exercise or physical activity, don't smoke cigarettes, maintaining a healthy weight, and eating a healthy diet with lots of fruits, vegetables, nuts, seeds, whole grains, and legumes (think Mediterranean-style diet). Don't want overdiagnosis and overtreatment (here, here, here, and here). Excerpts from Dr. John M:

I am changing…

The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing. Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.

But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.

I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.

More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.

A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine. It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.

 Image result for human heart in human body wikipedia Heart attacks run in the family? Does this mean you are doomed to also have a heart attack? Well, the good news from a large study is that a healthy lifestyle (with at least 3 of these 4 behaviors: not currently smoking, not being obese, regular physical activity at least once per week, and eating a good diet)  lowers the risk of a heart attack by nearly 50% even in those with a high genetic risk for heart attacks. (This is compared to those with an unhealthy lifestyle, which is none or only one healthy behavior.)  In this study a healthy diet was one with lots of fruits, nuts, vegetables, whole grains, fish, and dairy products, and a reduced amount of refined grains, processed meats, red meat, sugar-sweetened beverages, and trans fats.

The researchers also reversed the question and asked: "If you happen to inherit good genes, can a bad lifestyle offset that? We actually found yes." The risk of heart attack is also reduced nearly 50% in those people with good genes and a good lifestyle. BOTTOM LINE: Healthy lifestyle counts, no matter whether heart disease and heart attacks run in the family or not. There is an interaction between the two, From Science Daily:

Following a healthy lifestyle can greatly reduce genetic heart attack risk

It is well known that following a healthy lifestyle -- not smoking, avoiding excess weight and getting regular exercise -- can reduce the risk of heart disease. But what about people who have inherited gene variants known to increase risk? A study led by Massachusetts General Hospital (MGH) investigators has found that, even among those at high genetic risk, following a healthy lifestyle can cut in half the probability of a heart attack or similar event

"The basic message of our study is that DNA is not destiny," says Sekar Kathiresan, MD...."Many individuals -- both physicians and members of the general public -- have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case."  

In order to investigate whether a healthy lifestyle can mitigate genetic risk, the multi-institutional research team analyzed genetic and clinical data from more than 55,000 participants in four large-scale studies. Three of these studies....followed participants for up to 20 years. Each participant in the current analysis was assigned a genetic risk score....The investigators used four AHA-defined lifestyle factors -- no current smoking; lack of obesity (defined as a body mass index less than 30); physical exercise at least once a week; and a healthy dietary pattern -- to determine a lifestyle score, whether participants had a favorable (three or four healthy factors), intermediate (two factors) or unfavorable (one or no healthy factors) lifestyle.

Across all three prospective studies, a higher genetic risk score significantly increased the incidence of coronary events -- as much as 90 percent in those at highest risk. While known risk factors such as a family history and elevated LDL cholesterol were also associated with an elevated genetic risk score, genetic risk was the most powerful contributor to cardiac risk. Similarly, each healthy lifestyle factor reduced risk, and the unfavorable lifestyle group also had higher levels of hypertension, diabetes and other known risk factors upon entering the studies.

Within each genetic risk category, the presence of lifestyle factors significantly altered the risk of coronary events to such an extent that following a favorable lifestyle could reduce the incidence of coronary events by 50 percent in those with the highest genetic risk scores. Among participants in the BioImage study, both genetic and lifestyle factors were independently associated with levels of calcium-containing plaque in the coronary arteries, and healthy lifestyle factors were associated with less extensive plaque within each genetic risk group. [Original study]