摘要：Objectives. To review the contributions of the Nurses’ Health Studies (NHSs) to the understanding of cardiovascular disease etiology in women. Methods. We performed a narrative review of the publications of the NHS and NHS II between 1976 and 2016. Results. Diets low in trans fat, saturated fat, refined carbohydrates, and sugar-sweetened beverages and rich in fruits and vegetables, whole grains, and sources of unsaturated fats are associated with reduced risk of cardiovascular disease. Healthy lifestyle choices include smoking avoidance, regular physical activity, maintaining a normal body mass index, and moderate alcohol consumption. Adherence to a combination of these healthy diet and lifestyle behaviors may prevent most vascular events. Studies also covered oral contraceptive use, postmenopausal hormone therapy, shift work, sleep duration, psychosocial factors, and various biomarkers and genetic factors. Findings, such as the association of trans fat with cardiovascular disease, have helped shaped medical guidelines and government policies. Conclusions. The NHS has provided compelling evidence that the majority of vascular events may be prevented by avoiding smoking, participating in regular physical activity, maintaining normal body mass index, and eating a healthy diet. Cardiovascular disease (CVD) has remained the leading cause of death in the United States for more than 8 decades. 1 Since their inceptions in 1976 and 1989, the Nurses’ Health Studies (NHS) I and II, respectively, have contributed much new knowledge with the goal of reducing CVD incidence and mortality. A search on PubMed for the “Nurses’ Health Study,” “cardiovascular disease,” “myocardial infarction,” “heart disease,” and “stroke” yields more than 300 primary articles. Many more have been published related to the risk factors of CVD, such as hypertension. The breadth of exposures examined is great: dietary variables include macronutrients, micronutrients, nonnutrient dietary constituents, foods, beverages, and dietary patterns; lifestyle and other factors such as smoking, physical activity, adiposity, body fat distribution, sleep-related and psychosocial exposures characterize earlier studies from the NHS. The NHS research on exogenous hormone use, including oral contraceptives and postmenopausal hormone therapy, is addressed in Bhupathiratju et al. in this issue. More recently, biomarkers in plasma and red blood cells, as well as genetic factors, have been investigated. These articles have been included in many systematic reviews and have greatly contributed to clinical guidelines, public health campaigns, and government policies.
