The combined healthy lifestyle score is a protective factor for cardiovascular disease: a representative national cohort study in Taiwan

Abstract

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.

Comparison of Seven Healthy Lifestyle Scores Cardiometabolic Health: Age, Sex, and Lifestyle Interactions in the NutrIMDEA Web-Based Study

“…Additionally, the study of LS7 indicates that individuals with higher score on all seven metrics had a lower risk of CVD [ 19 ]. Similarly, it has been also found that improvement in these indices over time was associated with a lower risk of CVD in the future [ 56 ].…”

“…The most influential variables are modifiable factors which confirm the impact of lifestyle features in the HRQoL level measured by validated questionnaires [ 2 ]. Moreover, healthy lifestyle scores are significantly correlated with CVD risk of death and they are considered as an interesting tool in health promotion [ 15 , 56 , 62 ] Similarly, some authors have suggested that the combination of different lifestyle factors may improve the predictor accuracy of the risk of non-communicable diseases 1 .…”

“…These results support that an online method could be a useful instrument to implement both population recommendations and individual advice concerning LS7 [ 28 ] and LWB-I scores [ 36 , 42 , 66 ]. Indeed, combined indication of healthy lifestyle factors could be more favorable in health outcomes [ 56 ]. This has been reported concerning the adherence to health determinants, including PA and behavioral risk factors [ 67 ] and sociodemographic status interactions [ 5 ], in a prospective cohort concerning all cause of death [ 1 ].…”