就算有家族病史 你也可以戰勝心臟病

Billions of dollars are spent every year on medications that reduce the risk of heart disease —

每一年都有數十億美元被用於降低心臟病風險的藥物――

the No. 1 killer in the United States.

心臟病是美國人的第一大殺手。

But some people feel powerless to prevent it: Many of the risk factors seem baked into the cake at birth.

但在預防心臟病方面，有些人感到自己無能爲力：許多風險因素似乎在一個人出生之際便已形成。

Genetic factors can have a huge impact on people’s chances of dying of heart disease, and it has long been thought that those factors are almost always outside of one’s control.

遺傳因素會對人們死於心臟病的機率產生巨大影響，長期以來，這些因素被認爲幾乎總是無法人爲控制的。

Recent research contradicts this, though, and that should give us all renewed hope.

不過，近期的研究否定了這一點，應該能夠帶給我們所有人全新的希望。

Since the 1930s, we’ve recognized that heart disease runs in families.

自1930年代以來，我們已經認識到心臟病是有家族史的。

For the last decade, we’ve been able to identify specific genes that are linked to coronary artery disease.

在過去的十年中，我們已經能夠識別與冠狀動脈疾病相關的特定基因。

In fact, these genes seem to have a cumulative effect.

事實上，這些基因似乎具有累積效應。

People who have more of them are at greater risk.

擁有更多這種基因的人患病的風險也更大。

Familial factors are some of the strongest arguments for using drugs like statins widely.

家族性因素爲廣泛使用他汀類藥物提供了一些頗爲有力的論據。

After all, there’s only so much you can do about your cholesterol through diet and exercise changes.

畢竟，通過運動和飲食方面的變化來控制膽固醇，你能做的只有那麼多。

Some people can see reductions in cholesterol only through pharmacological intervention.

有些人不得不通過藥物干預來實現膽固醇的減少。

Still, we tend to treat those at low risk with lifestyle changes, while those at high risk get more intensive therapy.

我們仍然傾向於以生活方式的改變來處理那些低風險者，而讓高風險人羣接受更強化的治療。

A new study in The New England Journal of Medicine argues that thinking may be wrong.

《新英格蘭醫學雜誌》(The New England Journal of Medicine)的一項新研究認爲，這種思路可能是錯誤的。

Researchers gathered data from four large prospective cohort studies that followed thousands of people for years, looking at the relationships between various risk factors and heart disease.

研究人員收集了來自四個大型前瞻性隊列研究的數據，這些研究在多年中對數以千計的人們進行跟蹤調查，觀察各種危險因素與心臟病之間的關係。

The first began enrolling patients in 1987 and the last in 2008.

研究對患者的招募始於1987年，止於2008年。

Even though specific genes of interest weren’t known when these studies began, data were available that allowed scientists to evaluate genetic risk decades later.

雖然在剛開始時，研究者尚不瞭解任何讓他們感興趣的具體基因，但當年對數據的蒐集令科學家可以在幾十年後評估相關的遺傳風險。

Using about 50 different variations — single-nucleotide polymorphisms (otherwise known as SNPs) — researchers created a risk score.

研究者使用了約50種不同的變異――單核苷酸多態性（亦稱SNPs）――創建了風險評分系統。

They also looked at how lifestyle factors were associated with outcomes.

他們還研究了生活方式因素如何與結果相關。

These included not smoking cigarettes, not being obese (having a B.M.I. less than 30),

這些因素包括不吸菸，不肥胖（BMI指數小於30），

performing physical activity at least once a week and having a healthful diet pattern.

每週至少進行一次體育活動，並有健康的飲食模式。

That last criterion was defined as doing at least half of the following recommendations: eating more fruits, nuts, vegetables, whole grains, fish and dairy products and eating less refined grains, processed meats, unprocessed red meats, sugar-sweetened beverages, trans fats and sodium.

最後一項被定義爲至少做到以下建議的一半：更多食用水果、堅果、蔬菜、全穀物、魚和奶製品，較少食用精加工穀物、加工肉類、未加工的紅肉、加糖飲料、反式脂肪和鈉。

Every one of the four lifestyle factors was associated with a decreased risk of coronary events.

四種生活方式因素中的每一種都與冠狀動脈病變風險降低相關。

That’s the first bit of good news.

這是最初的一點好消息。

Doing any one of these things makes a difference.

做上述任何一件事情都會有所幫助。

But the effect is cumulative.

但效果是累積性的。

The researchers divided people into three groups based on these factors.

研究人員基於這些因素，將研究對象分爲三組。

Favorable required at least three of the four factors, intermediate required two of them, and unfavorable required one or none.

良好需要做到四個因素中的至少三個，中等需要做到其中兩個因素，而不良則是做到了其中的一個或沒有。

Across all studies, those with an unfavorable lifestyle had a risk that was 71 percent to 121 percent higher than those with a favorable lifestyle.

在所有研究中，生活方式不良組的風險比生活方式良好組的人高出71％至121％。

More impressive was the reduction in coronary events — heart attacks, bypass procedures and death from cardiovascular causes — at every level of risk.

更令人印象深刻的是每個風險級別內冠狀動脈病變（包括心臟病發作，冠狀動脈搭橋手術，以及心血管原因導致的死亡）的減少。

Those with a favorable lifestyle, compared with those with an unfavorable lifestyle, had a 45 percent reduction in coronary events among those at low genetic risk, a 47 percent reduction among those with intermediate genetic risk, and a 46 percent reduction among those at high genetic risk.

在低遺傳風險人羣中，生活方式良好者的冠狀動脈病變比生活方式不佳者少45％，在中等遺傳風險人羣中少47％，在高遺傳風險人羣中要少46％。

What does this mean in real-world numbers? Among those at high genetic risk in the oldest cohort study, 10.7 percent could expect to have a coronary event over a 10-year period if they had an unfavorable lifestyle.

這些摺合成現實生活中的數字意味着什麼？在時間最早的隊列研究中，遺傳風險高的人羣如果過着不良的生活方式，則有10.7％的人預期可能在10年內發生冠狀動脈病變。

That number was reduced to 5.1 percent if they had a favorable lifestyle.

如果他們過着良好的生活方式，這個數字則會減少到5.1％。

Among those at low genetic risk, the 10-year event rate was 5.8 percent with an unfavorable lifestyle and 3.1 percent with a favorable lifestyle.

在低遺傳風險的人羣中，過不良生活方式的人10年內發病率爲5.8％，過良好生活方式的人10年內發病率爲3.1％。

In the other cohort studies, similar relative reductions were seen.

其他隊列研究中，也可以看到類似的相應減少。

These differences aren’t small.

這些差別可不小。

The risk of a coronary event in 10 years was halved.

這意味着10年內冠狀動脈病變的風險減半。

The absolute reduction, more than 5 percentage points in the genetic group at high risk, means that lifestyle changes are as powerful as, if not more powerful than, many drugs we recommend and pay billions of dollars for all the time.

在高風險遺傳人羣中超過5個百分點的絕對減少值，就意味着生活方式的變化與我們一直以來所推薦的，價值數十億美元的許多藥物一樣有效，如果不是更有效的話。

There are caveats, of course.

當然，也有附加說明。

All of the participants in these analyses were white, because there are few well-validated genetic studies in black populations.

這些研究中的所有參與者都是白人，因爲在黑人人羣中罕有確定有效的遺傳研究。

But the researchers also saw similar findings in the black population of the oldest cohort.

但是研究人員在爲時最早的針對黑人人羣的隊列研究中也發現了類似的結果。

These aren’t randomized controlled trials, and there could be other factors at play that we aren’t measuring.

這些研究不是隨機對照試驗，也可能有其他我們並未予以衡量的因素在發揮作用。

But the results were consistent over a number of studies, and the effect size is large.

但是若干研究的結果是一致的，效應量很大。

There are important lessons to be learned.

我們可以從中得到重要的教訓。

These results should encourage us that genetics do not determine everything about our health.

這些結果應當鼓勵我們，遺傳學不能決定健康的全部。

Changes in lifestyle can overcome much of the risk our DNA imposes.

生活方式的變化可以克服DNA加諸於我們的大量風險。

Lifestyle changes are hugely important not only for those at low risk, but for those at high risk.

生活方式的變化不僅對於遺傳低風險的人羣來說非常重要，對於高風險人羣也非常重要。

The relative reductions in events were similar at all levels of genetic risk.

發病的相應減少在所有遺傳風險水平中都是相似的。

Moreover, given how changes in lifestyle will also reduce your risk of other diseases like cancer

此外，鑑於生活方式的改變也會降低患癌症

(the No. 2 killer), it’s clear that a healthier lifestyle could have huge implications for many, many more people.

（第二大殺手）的風險，更爲健康的生活方式顯然可能對更多、更多的人產生巨大的影響。

It’s important to acknowledge that these lifestyle recommendations are even less constrictive than those I’ve discussed in the past.

要承認，這些生活方式建議不像我過去曾經討論過的那些建議那樣嚴格，這一點也很重要。

You need only be a current nonsmoker; past smoking doesn’t exclude you.

你只需要從現在開始不吸菸就可以；過去的吸菸史並不妨礙你行動起來。

You can also be overweight, just not obese.

你可以超重，只要不肥胖就夠了。

And in contrast with most physical activity recommendations, it requires only once-a-week exercise, not the 30 minutes for five days that most professional organizations like the American Heart Association endorse.

與大多數鍛鍊建議相比，這個生活方式建議只需要每週一次的運動，而不是像美國心臟協會等大多數專業組織認可的每週鍛鍊五天，每次30分鐘。