By making four lifestyle changes, people in a recent study reduced their chances of dying by 80 percent.

A large study conducted in multiple locations by Johns Hopkins researchers found more evidence supporting the quadrangle of good health — a Mediterranean diet, exercise, weight maintenance, and abstaining from smoking.

The four lifestyle behaviors protected people from coronary heart disease as well as the early coagulation of calcium deposits in heart arteries, and reduced the risk of death from all causes over an eight-year period, researchers reported Monday in the American Journal of Epidemiology.

"To our knowledge, this is the first study to find a protective association between low-risk lifestyle factors and early signs of vascular disease, coronary heart disease and death, in a single longitudinal evaluation," Dr. Haitham Ahmed, M.D., an internal medicine resident at Johns Hopkins, told reporters.

Investigators followed a sample of more than 6,200 men and women — comprised of white, African-American, Hispanic, and Chinese people — for nearly eight years. "Those who adopted all four healthy behaviors had an 80 percent lower death rate over that time period compared to participants with none of the healthy behaviors," Ahmed said.

With no previous diagnosis of heart disease, the men and women were recruited at six medical centers for a study on heart disease called the Multi-Ethnic Study of Atherosclerosis. At the beginning of the study, study participants were assessed for the extent of calcium deposits in heart arteries, which increase the risk of heart attack. Later in the study, researchers recorded heart-related events in the participants, including heart attack, sudden cardiac arrest, chest pains, angioplasty, or death from coronary heart disease and other causes.

The men and women then received health scores based on diet, body mass index (BMI), levels of exercise, and whether or not they smoked, ranging from an unhealthy 0 to a healthiest score of 4. Only two percent, or 129 men and women, received the highest score.

Dr. Roger Blumenthal, M.D., a cardiologist and professor of medicine at the Johns Hopkins University School of Medicine, led the study. "Of all the lifestyle factors, we found that smoking avoidance played the largest role in reducing the risk of coronary heart disease and mortality," he said. "In fact, smokers who adopted two or more of the healthy behaviors still had lower survival rates after 7.6 years than did nonsmokers who were sedentary and obese."

Blumenthal, also the president of the Maryland affiliate of the American Heart Association, said the findings "bolster recent recommendations by the American Heart Association, which call for maintaining a diet rich in vegetables, fruits, nuts, whole grains and fish, keeping a BMI of less than 25, being physically active and not smoking."

However, the research supports the notion that the four lifestyle behaviors reduced the risk of death across the board, not just from heart disease, Ahmed said. "While there are risk factors that people can't control, such as their family history and age, these lifestyle measures are things that people can change and consequently make a big difference in their health," he said. "That's why we think this is so important."

The study was supported by the U.S. National Heart, Lung, and Blood Institutes of Health.

Source: Blumenthal R, Blaha MJ, Nasir K, et al. Low-Risk Lifestyle, Coronary Calcium, Cardiovascular Events, and Mortality: Results from the Multi-Ethnic Study of Atherosclerosis. The American Journal of Epidemiology. 2013.