Billions of dollars are spent every year on medications that reduce the risk of heart disease — 每一年都有数十亿美元被用作减少心脏病风险的药物――the No. 1 killer in the United States.心脏病是美国人的第一大刺客。But some people feel powerless to prevent it: Many of the risk factors seem baked into the cake at birth. 但在防治心脏病方面，有些人深感自己无能为力：许多风险因素或许在一个人出生于之际之后已构成。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.遗传因素不会对人们杀于心脏病的几率产生极大影响，长期以来，这些因素被指出完全总是无法人为掌控的。Recent research contradicts this, though, and that should give us all renewed hope.不过，近期的研究驳斥了这一点，应当需要带来我们所有人全新的期望。

Since the 1930s, we’ve recognized that heart disease runs in families. 自1930年代以来，我们早已认识到心脏病是有家族史的。For the last decade, we’ve been able to identify specific genes that are linked to coronary artery disease. 在过去的十年中，我们早已需要辨识与冠状动脉疾病相关的特定基因。

In fact, these genes seem to have a cumulative effect. 事实上，这些基因或许具备积累效应。People who have more of them are at greater risk.享有更加多这种基因的人患病的风险也更大。Familial factors are some of the strongest arguments for using drugs like statins widely. 家族性因素为普遍用于他汀类药物获取了一些极为有力的论据。

After all, there’s only so much you can do about your cholesterol through diet and exercise changes. 却是，通过运动和饮食方面的变化来掌控胆固醇，你能做到的只有那么多。Some people can see reductions in cholesterol only through pharmacological intervention.有些人被迫通过药物介入来构建胆固醇的增加。Still, we tend to treat those at low risk with lifestyle changes, while those at high risk get more intensive therapy. 我们依然偏向于以生活方式的转变来处置那些较低风险者，而让高风险人群拒绝接受更加增强的化疗。

A new study in The New England Journal of Medicine argues that thinking may be wrong.《新英格兰医学杂志》(The New England Journal of Medicine)的一项新的研究指出，这种思路有可能是错误的。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. 研究人员搜集了来自四个大型前瞻性队列研究的数据，这些研究在多年中对数以千计的人们展开跟踪调查，仔细观察各种危险性因素与心脏病之间的关系。The first began enrolling patients in 1987 and the last in 2008. 研究对患者的召募始自1987年，相接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. 虽然在刚开始时，研究者尚能不理解任何让他们感兴趣的明确基因，但当年对数据的收集令其科学家可以在几十年后评估涉及的遗传风险。Using about 50 different variations — single-nucleotide polymorphisms (otherwise known as SNPs) — researchers created a risk score.研究者用于了大约50种有所不同的变异――单核苷酸多态性（亦称SNPs）――创立了风险评分系统。

They also looked at how lifestyle factors were associated with outcomes. 他们还研究了生活方式因素如何与结果涉及。These included not smoking cigarettes, not being obese (having a B.M.I. less than 30), 这些因素还包括不吸烟者，不体重增加（BMI指数大于30），performing physical activity at least once a week and having a healthful diet pattern.每周最少展开一次体育活动，并有身体健康的饮食模式。

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. 最后一项被定义为最少做以下建议的一半：更加多食用水果、坚果、蔬菜、全谷物、鱼和奶制品，较较少食用精加工谷物、加工肉类、未加工的红肉、冲泡饮料、反式脂肪和钠。Every one of the four lifestyle factors was associated with a decreased risk of coronary events.四种生活方式因素中的每一种都与冠状动脉恶性肿瘤风险减少涉及。That’s the first bit of good news. 这是最初的一点好消息。

Doing any one of these things makes a difference.做到上述任何一件事情都会有所协助。But the effect is cumulative. 但效果是累积性的。The researchers divided people into three groups based on these factors. 研究人员基于这些因素，将研究对象分成三组。Favorable required at least three of the four factors, intermediate required two of them, and unfavorable required one or none. 较好必须做四个因素中的最少三个，中等必须做其中两个因素，而不当则是做了其中的一个或没。

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，生活方式不当组的风险比生活方式较好组的人高达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. 更加令人印象深刻印象的是每个风险级别内冠状动脉恶性肿瘤（还包括心脏病发作，冠状动脉脑瘤手术，以及心血管原因造成的丧生）的增加。

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.在较低遗传风险人群中，生活方式较好者的冠状动脉恶性肿瘤比生活方式不欠佳者较少45％，在中等遗传风险人群中较少47％，在低遗传风险人群中要少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. 这些折算成现实生活中的数字意味著什么？在时间最先的队列研究中，遗传风险低的人群如果过着不当的生活方式，则有10.7％的人预期有可能在10年内再次发生冠状动脉恶性肿瘤。That number was reduced to 5.1 percent if they had a favorable lifestyle. 如果他们过着较好的生活方式，这个数字则不会增加到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. 在较低遗传风险的人群中，过不当生活方式的人10年内发病率为5.8％，过较好生活方式的人10年内发病率为3.1％。

In the other cohort studies, similar relative reductions were seen.其他队列研究中，也可以看见类似于的适当增加。These differences aren’t small. 这些差异可极大。The risk of a coronary event in 10 years was halved. 这意味著10年内冠状动脉恶性肿瘤的风险减为。

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.在高风险遗传人群中多达5个百分点的意味著增加值，就意味著生活方式的变化与我们仍然以来所引荐的，价值数十亿美元的许多药物一样有效地，如果不是更加有效地的话。There are caveats, of course. 当然，也有可选解释。All of the participants in these analyses were white, because there are few well-validated genetic studies in black populations. 这些研究中的所有参与者都是白人，因为在黑人人群中难得确认有效地的遗传研究。

But the researchers also saw similar findings in the black population of the oldest cohort. 但是研究人员在为时最先的针对黑人人群的队列研究中也找到了类似于的结果。These aren’t randomized controlled trials, and there could be other factors at play that we aren’t measuring. 这些研究不是随机对照试验，也有可能有其他我们未不予取决于的因素在发挥作用。

But the results were consistent over a number of studies, and the effect size is large.但是若干研究的结果是完全一致的，效应量相当大。There are important lessons to be learned. 我们可以借此获得最重要的教训。These results should encourage us that genetics do not determine everything about our health. 这些结果应该希望我们，遗传学无法要求身体健康的全部。Changes in lifestyle can overcome much of the risk our DNA imposes.生活方式的变化可以解决DNA诸般于我们的大量风险。

Lifestyle changes are hugely important not only for those at low risk, but for those at high risk. 生活方式的变化不仅对于遗传较低风险的人群来说十分最重要，对于高风险人群也十分最重要。The relative reductions in events were similar at all levels of genetic risk.发作的适当增加在所有遗传风险水平中都是相近的。Moreover, given how changes in lifestyle will also reduce your risk of other diseases like cancer 此外，鉴于生活方式的转变也不会减少患癌症(the No. 2 killer), it’s clear that a healthier lifestyle could have huge implications for many, many more people.（第二大刺客）的风险，更加身体健康的生活方式似乎有可能对更好、更好的人产生极大的影响。It’s important to acknowledge that these lifestyle recommendations are even less constrictive than those I’ve discussed in the past. 要否认，这些生活方式建议不像我过去曾多次辩论过的那些建议那样严苛，这一点也很最重要。

You need only be a current nonsmoker; past smoking doesn’t exclude you. 你只必须从现在开始不吸烟者就可以；过去的吸烟史并不阻碍你行动起来。You can also be overweight, just not obese. 你可以超载，只要不体重增加就不够了。

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.与大多数磨练建议比起，这个生活方式建议只必须每周一次的运动，而不是像美国心脏协会等大多数专业的组织接纳的每周磨练五天，每次30分钟。

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