Impact of healthy lifestyle on mortality in people with normal blood pressure, LDL cholesterol, and C-reactive protein

Eur J Prev Cardiol. 2013 Feb;20(1):73-9. doi: 10.1177/1741826711425776. Epub 2011 Sep 30.


Background: To investigate the impact of healthy lifestyle on cardiovascular risk and mortality in people without a history of cardiovascular disease and without elevation of lipid, blood pressure, or inflammatory markers.

Design: Cohort study.

Methods: Study of a diverse sample of adults in the NHANES III follow-up Mortality Survey, to determine the benefit of adhering to healthy lifestyle habits (five or more fruits and vegetables/day, regular exercise, or being non-obese (body mass index 18.5-29.9 kg/m(2)), no current smoking, moderate alcohol consumption) in adults without common cardiovascular risk factors such as elevated cholesterol (low-density lipoprotein, LDL, cholesterol >130 mg/dl), inflammation (C-reactive protein, CRP, >3.0 mg/l, or hypertension (blood pressure >140/90 mmHg).

Results: Of 11,841 participants, 14.9% were adherent to all five healthy habits. After controlling for age, race, and gender, individuals with lower LDL cholesterol (HR 6.33, 95% CI 2.80-14.30), low CRP (HR 3.48, 95% CI 2.23-5.41), or normal blood pressure (HR 2.87, 95% CI 1.58-5.20) and 0-1 healthy habits had significantly higher all-cause (shown) and cardiovascular mortality than people adhering to all five healthy habits. People without common risk factors and lacking only 1-2 of the healthy habits remained at higher risk of all-cause mortality.

Conclusions: People without a history of cardiovascular disease who lack common cardiovascular risk factors remain at significantly greater risk of cardiovascular and all-cause mortality if they do not adhere to a healthy lifestyle. Strategies to encourage adopting healthy lifestyles should be implemented among individuals across all risk levels.

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking
  • Blood Pressure / physiology*
  • Body Mass Index
  • C-Reactive Protein / metabolism*
  • Cardiovascular Diseases / mortality*
  • Cholesterol, LDL / blood*
  • Cohort Studies
  • Cross-Sectional Studies
  • Diet
  • Exercise
  • Female
  • Humans
  • Life Style*
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prospective Studies
  • Risk Factors
  • Smoking
  • Young Adult


  • Cholesterol, LDL
  • C-Reactive Protein