Seven modifiable lifestyle factors predict reduced risk for ischemic cardiovascular disease and all-cause mortality regardless of body mass index: a cohort study

Abstract

Objectives: A healthy lifestyle has an impact on cardiovascular health. Yet, the importance of body mass index (BMI) and gender remains less clear. The aim of this study was to investigate whether healthy lifestyle factors can predict incident cardiovascular disease (CVD) and all-cause mortality.

Methods: Representative population-based prospective cohort study of 60-year-old women (n=2193) and men (n=2039). The following factors related to a healthy lifestyle were assessed using a questionnaire: non-smoking, alcohol intake of 0.6-30 g/day, moderate physical activity at least once a week, low intake of processed meats, weekly intake of fish, daily intake of fruit, and daily intake of vegetables. These factors were combined to produce a total score of healthy lifestyle factors (0-7) and classified into four groups: unhealthy (0-2 lifestyle factors), intermediate (3), healthy (4-5), and very healthy (6-7). National registers enabled identification of incident CVD (n=375) and all-cause mortality (n=427) over a follow-up of 11 years.

Results: Very healthy women and men exhibited a decreased risk for incident CVD compared with unhealthy individuals, with hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for educational level and BMI of 0.44 (0.26-0.75) and 0.39 (0.25-0.61), respectively. The corresponding HRs (95% CIs) for all-cause mortality for very healthy women and men were 0.25 (0.15-0.44) and 0.35 (0.23-0.54), respectively.

Conclusion: With seven healthy lifestyle factors, it was possible to identify men and women with substantially lower relative risks of incident CVD and death, regardless of BMI and educational level.

Keywords: Alcohol consumption; Fish intake; Fruit and vegetable consumption; Physical activity; Processed meat; Tobacco smoking.