Jensen et al. analyzed the associations of obesity [defined using body mass index (BMI)] in combination with physical activity, smoking, and a Mediterranean diet with the risk of acute coronary syndrome (ACS) in a prospective, population-based study of 54,783 middle-aged men and women. They found that obesity was strongly associated with the risk of ACS among the physically active and inactive, in nonsmokers and smokers, among those who adhered to a more or less heart-healthy dietary pattern, and in participants with and without a moderate alcohol intake. BMI was also associated with ACS in subgroups without important clinical risk factors, suggesting that prevention of obesity is important even in those who adhere to an otherwise healthy lifestyle or who are free of clinical symptoms. These results suggest that increasing physical activity, abstaining from smoking, consuming a more heart-healthy diet, and having a moderate alcohol intake likely lower the risk of acute coronary syndrome, even in obese individuals. This article was accompanied by an editorial by Poirier who stressed that assessments of adiposity (using BMI) and physical activity (self-reported) may have introduced biases, but the study’s size probably compensated for any problems. The editorial also underlined the fact that in addition to improving the clinical environment by providing more interdisciplinary support, public health policies should focus on early prevention of overweight/obesity by creating favourable and permissive environments for healthy eating habits and more physical activity/exercise, which should be implemented very early in life.
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