Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis

Abstract

Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15-4.52) for CHD incidence, 2.09 (95% CI 1.51-2.89) for stroke incidence, 2.76 (95% CI 1.62-4.71) for CVD mortality and 2.22 (95% CI 1.92-2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67-0.80) for overall CVD, 0.71 (95% CI 0.67-0.75) for CHD, 0.77 (95% CI 0.70-0.85) for stroke, 0.70 (95% CI 0.58-0.84) for CVD mortality and 0.71 (95% CI 0.65-0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56-0.91) for CHD, 0.63 (95% CI 0.57-0.71) for CVD mortality and 0.80 (95% CI 0.76-0.84) for all-cause mortality. For women with BMI 30-35 kg/m the risk was 1.67 (95% CI 1.24-2.25) for CHD and 2.3 (95% CI 1.56-3.40) for CVD mortality, compared to normal weight. Each 5 kg/m increase in BMI was associated with 24% (95% CI 16-33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.

Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK

“…For non-communicable disease outcomes, lifestyle risk factors have been consistently associated with morbidity, mortality and loss of disease-free years of life. [1][2][3][4] There are also population cohort data on possible adverse effects of poor lifestyle on serious respiratory infections. For example, physical inactivity and smoking appear to be independently associated with higher risk of community-acquired pneumonia and pneumonia mortality.…”

Impact of combined healthy lifestyle factors on survival in an adult general population and in high‐risk groups: prospective results from the Moli‐sani Study

“…Taken individually, these easily modifiable lifestyle factors are associated with improved survival and reduced risk of major chronic diseases , and several studies have shown that a combination of healthy lifestyle choices has a greater health impact than any single lifestyle factor.…”

“…Taken individually, these easily modifiable lifestyle factors are associated with improved survival and reduced risk of major chronic diseases [4,5], and several studies have shown that a combination of healthy lifestyle choices has a greater health impact than any single lifestyle factor. Indeed, simultaneous adherence to low-risk lifestyle factors was reportedly effective in reducing the risk of diseases such as coronary heart disease [6,7], stroke [8], heart failure [9], diabetes [10] and to substantially increase survival in men and women [11,12].…”

Risk factors associated with intestinal permeability in an adult population: A systematic review

“…This similarity further strengthens the identified risk factors as valuable clinical features healthcare professionals may consider as part of their differential diagnosis. Many of the risk factors identified have previously been reported as major risk factors for morbidity and mortality in chronic diseases worldwide . Therefore, IP may be considered a feature of chronic disease rather than merely a digestive health issue.…”

“…Participants Descriptive data Key results Limitations Interpretation Generalisability Funding 12d 12e 13a 13b 13c 14a 14b 14c 15 16a 16b 16c 17 18 19 20 21 22 74,75 Therefore, IP may be considered a feature of chronic disease rather than merely a digestive health issue.…”