Key result
Nonsmoking is linked to an absolute ~3-4% reduction in 10-year major cardiovascular events.
Why the study?
Recommendations for cardiovascular prevention increasingly focus on global risk assessment in lower risk individuals where lifestyle changes may reduce pharmacotherapy need, but quantifying these benefits is difficult, undermining adherence.
Do favorable lifestyle factors (avoiding smoking, obesity, inactivity, and daily alcohol) reduce the 10-year risk of cardiovascular death, non-fatal MI, or stroke in individuals without prior CVD?
Cohort (n=371,102)
Do favorable lifestyle factors (avoiding smoking, obesity, inactivity, and daily alcohol) reduce the 10-year risk of cardiovascular death, non-fatal MI, or stroke in individuals without prior CVD?
Smoking avoidance/cessation provides the largest absolute reduction in 10-year cardiovascular risk among modifiable lifestyle factors in individuals without prior CVD.
Answers are grounded in this paper and cite their sources.
Smoking cessation may maximize 10-year CV risk reduction in primary prevention; extends causal ML estimates but leaves effects open to trial confirmation.
Background Increasingly recommendations for prevention focus on global risk assessment in lower risk individuals where sufficient lifestyle changes may reduce the need for pharmacotherapy; yet these benefits are hard to quantify, undermining adherence. We aimed to derive a tool that personalises the cardiovascular benefit associated with lifestyle risk factors. Methods Baseline exposures were linked to longitudinal outcomes in 371,102 UK Biobank participants without prior CVD. Causal effects were estimated using directed acyclic graphs with inverse propensity weighting (IPW), augmented IPW, generalised linear models, and causal machine learning for smoking (former/never vs current), obesity (BMI <30 vs ≥30 kg/m²), physical activity (≥600 vs <600 MET-minutes/week), and alcohol (less-than-daily vs daily). The outcome was a 10-year composite of cardiovascular death, non-fatal MI, or stroke. Results Median age was 58 years (IQR 50–63), 56% female; 15,752 CVD events occurred over ten years. The largest risk difference was for former/never versus current smoking (absolute risk difference [ARD] 3.2–3.8%), followed by BMI <30 versus ≥30 kg/m² (ARD 1.0–1.1%) and higher versus lower physical activity (ARD 0.2–0.4%); less-than-daily versus daily alcohol carried a small but higher risk. Differences were larger at higher baseline risk and with co-existing risk factors, increasing with pack-year for smoking (β=+0.23% per SD), and were slightly lower at higher BMI (β=−0.04%). Conclusion Among the lifestyle risk factors examined, smoking provided the largest risk difference, increasing with pack-years. Estimates for BMI were smaller and broadly consistent across the obesity range. Findings are accessible via a free tool (lifestyle-cvd.casefinding.com).
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Stevens et al. (2026) conducted a cohort in Cardiovascular risk without prior CVD (n=371,102). Former/never smoking, BMI <30 kg/m², higher physical activity, and less-than-daily alcohol vs. Current smoking, BMI ≥30 kg/m², lower physical activity, and daily alcohol was evaluated on 10-year composite of cardiovascular death, non-fatal MI, or stroke (ARD 3.2-3.8% for former/never vs current smoking). Former or never smoking versus current smoking yielded the largest absolute risk difference (3.2-3.8%) for 10-year cardiovascular events, followed by maintaining a BMI <30 kg/m² (1.0-1.1%).
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