Want to really improve your chances of preventing heart disease?

Learn how lifestyle factors cut your risk. Here they are:

1. Not smoking cigarettes 

2. Not being obese (having a B.M.I. less than 30) 

3. Performing physical activity at least once a week. 

4. Having a healthful diet pattern.

Here is what defines a healthful diet pattern. Do at least half of these things: eat more fruits, nuts, vegetables, whole grains, fish and dairy products; eat less processed meats, unprocessed red meats, sugar sweetened beverages, trans fats and sodium.

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

That’s the first bit of good news. Doing any one of these things makes a difference.

But the effect is cumulative. The researchers divided people into three groups based on these factors. “Favorable” required at least three of the four factors, “intermediate” required two of them, and “unfavorable” required one or none. 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.

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

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. That number was reduced to 5.1 percent if they had a favorable lifestyle. 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. In the other cohort studies, similar relative reductions were seen.

These differences aren’t small. The risk of a coronary event in 10 years was halved. 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.

There are important lessons to be learned. These results should encourage us that genetics do not determine everything about our health. Changes in lifestyle can overcome much of the risk our DNA imposes.

Lifestyle changes are hugely important not only for those at low risk, but for those at high risk. The relative reductions in events were similar at all levels of genetic risk.

Remember that changes in lifestyle also reduce your risk of cancer, the number two killer making it clear that a healthy lifestyle has implications for an even greater number of us!