The Lifestyle Medicine Health Behavior Scale and Cardiovascular Disease: A Prospective Cohort Study From the UK Biobank

INTRODUCTION: Cardiovascular disease remains the leading cause of death globally, with modifiable lifestyle factors being paramount in its prevention. However, comprehensive tools to evaluate adherence to healthy lifestyle behaviors are limited. The modified Lifestyle Medicine Health Behavior scale was developed to assess the 6 pillars of lifestyle medicine: nutrition, physical activity, sleep, stress management, social connection, and substance use (smoking status). METHODS: A cohort of 447,311 individuals aged 40-70 years from the UK Biobank who were free of cardiovascular disease at baseline (2009-2012) and were followed up to 2021 was used. The modified Lifestyle Medicine Health Behavior scale score was calculated using self-reported data on its 6 pillars and had a possible range of 23-102 points (a higher score indicated a better lifestyle). Cardiovascular disease incidence was defined as primary myocardial infarction or stroke and was obtained from clinical records and death registries. Study associations were analyzed using multivariable Cox regression models. RESULTS: During a 12.55-year median follow-up, 16,168 events of cardiovascular disease occurred. The multivariable-adjusted hazard ratio (95% CI) comparing participants in the highest with those in the lowest quintile of the modified Lifestyle Medicine Health Behavior score was 0.66 (0.63, 0.70) for cardiovascular disease, 0.66 (0.61, 0.70) for myocardial infarction, 0.65 (0.54, 0.78) for hemorrhagic stroke, and 0.68 (0.62, 0.74) for ischemic stroke; all p-trends were <0.001. A continuous inverse dose-response association was found in the spline analysis. Results remained robust in several sensitivity analyses. Substance use, followed by sleep, nutrition, and physical activity, were the strongest contributors to cardiovascular disease risk reduction, whereas stress management and social connection showed weaker associations. CONCLUSIONS: In this large cohort of middle-aged and older British adults, the modified Lifestyle Medicine Health Behavior scale, a comprehensive tool for assessing lifestyle behaviors, was strongly associated with a lower cardiovascular disease risk. These findings highlight the impact of healthy lifestyle behaviors on cardiovascular disease prevention.