Joint Association of Modifiable Lifestyle and Metabolic Health Status with Incidence of Cardiovascular Diabetes and All-Cause mortality: A Perspective Cohort Study

Background We investigated the joint associations of modifiable lifestyle and metabolic factors with incident cardiovascular disease (CVD) and all-cause mortality. Methods This study included 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of CVD at baseline from Kailuan study during 2006 to 2007 and followed them until new-onset CVD event, death or December 31, 2017. Baseline metabolic health status was assessed by Adult Treatment Panel-III (ATP-III) criteria and five lifestyle factors was collected using a self-reported questionnaire. We performed Cox proportional hazards models to evaluate the joint associations. Results During a median follow-up of 11.03 years, we observed 6,590 CVD events and 9,218 all-cause mortality. Participants within more metabolic risk components and least healthy lifestyle had the highest CVD risk (hazard ratio [HR] 2.06 [95% CI 1.77-2.39]) and mortality risk (HR 1.53 [95% CI 1.31-1.78]), as compared with the less metabolic risk components and most healthy lifestyle group. Compared with the most healthy lifestyle, the HR of CVD for participants with least healthy lifestyle was 1.26 (95% CI 1.17–1.37) in the category with low metabolic risk, 1.16 (95% CI 1.03–1.31) and 1.07 (95% CI 0.90–1.27) for those with medium and high metabolic risk, respectively. Conclusions We showed that healthy lifestyle and metabolic health were associated with a lower risk of CVD and all-cause mortality. The association between metabolic risk and the risk of CVD was not modified by healthy lifestyle. Our results indicated that healthy lifestyle should be promoted even for people with high metabolic risk.