Joint associations of multiple healthy lifestyles with the risk of cardiovascular disease: a prospective cohort study of UK Biobank

Cardiovascular disease (CVD) is a major contributor to disability and the leading cause of global mortality. This study aims to perform a population-based prospective cohort study to examine the combined impact of multiple lifestyle factors on CVD risk and examine the differences in the relationships across sociodemographic groups. We used data from the UK Biobank. Exposures include seven lifestyle behaviors (smoking, physical activity, alcohol consumption, diet, sleep duration, sedentary behavior, and social connection) and combined multiple behaviors. The lifestyle score was subsequently categorized as favorable (5 to 7 healthy lifestyle factors), intermediate (2 to 4 healthy lifestyle factors), and unfavorable (0 to 1 healthy lifestyle factor) lifestyle classes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD and its subtypes. This study showed a significant association of favorable lifestyle with incident CVD (HR = 0.58, 95% CI: 0.54-0.63), myocardial infarction (HR = 0.58, 95% CI: 0.54-0.64), and ischemic stroke (HR = 0.56, 95% CI: 0.48-0.65). Similarly, there was a significant association of intermediate lifestyle with incident CVD (HR = 0.69, 95% CI: 0.64-0.75), myocardial infarction (HR = 0.70, 95% CI: 0.64-0.77), and ischemic stroke (HR = 0.66, 95% CI: 0.57-0.77). The protection effect of lifestyle was more pronounced in the midlife group, females, and those individuals with high Townsend deprivation index levels. Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of CVD and subtypes. Lifestyle modification through multifactorial approaches should be prioritized for preventing and delaying onset of CVD.