Key result
Highest simple Taiwan healthy lifestyle score linked to ~57% lower CVD risk versus lowest category.
Why the study?
The protective effect of different healthy lifestyle scores for CVD risk has been reported, but comparisons of their performance were lacking.
Does adherence to a healthy lifestyle score reduce the incidence of cardiovascular disease in adults free of CVD at baseline?
Cohort (n=6,042)
Does adherence to a healthy lifestyle score reduce the incidence of cardiovascular disease in adults free of CVD at baseline?
Higher adherence to healthy lifestyle scores significantly reduces the long-term risk of cardiovascular disease, particularly in younger adults, and improves risk prediction models.
Supports lifestyle scoring in primary prevention models; extends validation to Taiwanese adults but leaves causal effects open pending trials.
BackgroundThe protective effect of different healthy lifestyle scores for the risk of cardiovascular disease (CVD) was reported but the comparisons of performance were lack. We compared the performance measures of cardiovascular diseases from different healthy lifestyle scores among adult Taiwan.MethodsWe conducted a nationwide prospective cohort study of 6042 participants (median age 43 years, 50.2% women) in Taiwan’s Hypertensive, Hyperglycemia and Hyperlipidemia Survey, 2002 who were free of CVD at baseline. Simple and weighted Taiwan healthy lifestyle score was defined as combination of normal body mass index, Mediterranean diet, adequately physical activity, not smoking and regular healthy drinking and each dichotomous lifestyle factor. World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) cancer prevention recommended lifestyle and Life's Simple 7 following the guideline definition. The incidence of cardiovascular disease incidence among the 4 healthy lifestyle score each divided into 4 groups based on scores were estimated.ResultsDuring a median 14.3 years follow-up period, totally 520 cases developed CVD events. In multivariate-adjusted Cox proportional hazard models, adherence to highest category compared with lowest one of simple Taiwan lifestyle score for hazard ratio 0.43 (95% confidence interval [CI] 0.2, 0.94) and weighted Taiwan lifestyle score for 0.44 (95%CI 0.28, 0.68) were independently and significantly. In addition, age played a significant effect modifier for the protective effect of healthy lifestyle scores for CVD risk. Specifically, when the simple and weighted Taiwan healthy lifestyle score were added to the classical model, the Harrell’s C-statistic increasing from 0.85 to 0.86 (95% confidence interval [CI], 0.84, 087; Pdiff=0.02) in both lifestyle scores. The performance measures by integrated discriminative improvement showed significant increasing after adding simple Taiwan healthy lifestyle score (integrated discriminative improvement: 0.51, 95% CI 0.16, 0.86, P=0.002) and weighted Taiwan lifestyle score (integrated discriminative improvement: 0.38, 95% CI 0.01,0.74, P=0.021) information.Conclusions We demonstrated that healthy lifestyle scores with an inverse association with CVD, and the reduction of CVD risk was more for young adults than for old adult. Further investigations to study the mechanism of lifestyle role on CVD prevention are warranted.
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Tsai et al. (2021) conducted a cohort in Cardiovascular disease (n=6,042). Highest category of simple Taiwan healthy lifestyle score vs. Lowest category of simple Taiwan healthy lifestyle score was evaluated on Incidence of cardiovascular disease events (HR 0.43, 95% CI 0.2-0.94). Adherence to the highest category of the simple Taiwan healthy lifestyle score was associated with a significantly lower risk of cardiovascular disease (HR 0.43) compared to the lowest category.
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