Four out of five heart attacks in men may be prevented by adopting a healthy lifestyle, according to a study published today in the Journal of the American Heart Association.

Healthy lifestyle behaviors include moderate alcohol use, not smoking, maintaining a healthy weight and diet and getting regular exercise, say the Swedish researchers who conducted the study.

Additional benefits of healthy lifestyles include avoiding side effects of drugs used to prevent cardiac events and costs savings for individuals and populations.

The researchers followed just over 20,000 Swedish men, ages 45 to 79, for 11 years. They used questionnaires to ask about diet, alcohol and tobacco use, physical activity. They also asked about belly fat, another heart attack risk factor.

Men with the lowest risk for cardiac events were those who didn’t smoke, walked or biked for at least 40 minutes per day, exercised at least one hour per week, had a waist circumference below 95 centimeters, consumed moderate amounts of alcohol, and regularly ate a diet high in fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains and fish.

The researchers found a reduced risk for a heart attack for each individual lifestyle factor the participants practiced. Combining more lifestyle changes reduce the risk of a heart attack even more. For example, men who combined the low-risk diet and moderate alcohol consumption with not smoking, being physically active and having a low amount of abdominal fat, had an 86 percent lower heart attack risk.

“It is not surprising that healthy lifestyle choices would lead to a reduction in heart attacks,” said Agneta Akesson, Ph.D., Associate Professor at the Institute of Environmental Medicine at the Karolinska Institute in Stockholm, and the lead author of the study. “What is surprising is how drastically the risk dropped due to these factors.”

According to the authors, less than 2 percent of the American population practices “ideal cardiovascular health,” even though the rate of cardiovascular disease could be vastly reduced if they did.

“It is important to note that these lifestyle behaviors are modifiable, and changing from high-risk to low-risk behaviors can have great impact on cardiovascular health,” says Dr Akesson, adding “however, the best thing one can do is adopt healthy lifestyle choices early in life.”