Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults

Mayo Clin Proc. 2016 Apr;91(4):432-42. doi: 10.1016/j.mayocp.2016.01.009. Epub 2016 Feb 20.


Objective: To estimate the prevalence of healthy lifestyle characteristics and to examine the association between different combinations of healthy lifestyle characteristics and cardiovascular disease biomarkers.

Patients and methods: The prevalence of healthy lifestyle characteristics was estimated for the US adult population (N=4745) using 2003-2006 National Health and Nutrition Examination Survey data for the following parameters: being sufficiently active (accelerometer), eating a healthy diet (Healthy Eating Index based on 24-hour recalls), being a nonsmoker (serum cotinine level), and having a recommended body fat percentage (dual-energy X-ray absorptiometry). Cardiovascular biomarkers included mean arterial pressure, C-reactive protein, white blood cells (WBCs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, fasting low-density lipoprotein cholesterol, fasting triglycerides, fasting glucose, fasting insulin, insulin resistance, hemoglobin A1c, and homocysteine. The study was conducted from August 15, 2013, through January 5, 2016.

Results: Only 2.7% (95% CI, 1.9%-3.4%) of all adults had all 4 healthy lifestyle characteristics. Participants with 3 or 4 compared with 0 healthy lifestyle characteristics had more favorable biomarker levels except for mean arterial blood pressure, fasting glucose, and hemoglobin A1c. Having at least 1 or 2 compared with 0 healthy lifestyle characteristics was favorably associated with C-reactive protein, WBCs, HDL-C, total cholesterol, and homocysteine. For HDL-C and total cholesterol, the strongest correlate was body fat percentage. For homocysteine, a healthy diet and not smoking were strong correlates; for WBCs, diet was not a strong correlate.

Conclusion: Although multiple healthy lifestyle characteristics are important, specific health characteristics may be more important for particular cardiovascular disease risk factors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood*
  • Body Mass Index
  • Cardiovascular Diseases / epidemiology*
  • Cholesterol, HDL / blood*
  • Cholesterol, LDL / blood*
  • Diet / adverse effects*
  • Female
  • Humans
  • Life Style*
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • Risk Factors
  • Triglycerides / blood*
  • United States / epidemiology
  • Young Adult


  • Biomarkers
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Triglycerides