Background: To investigate the impact of healthy lifestyle on cardiovascular risk and mortality in people without a history of cardiovascular disease and without elevation of lipid, blood pressure, or inflammatory markers.
Design: Cohort study.
Methods: Study of a diverse sample of adults in the NHANES III follow-up Mortality Survey, to determine the benefit of adhering to healthy lifestyle habits (five or more fruits and vegetables/day, regular exercise, or being non-obese (body mass index 18.5–29.9 kg/m2), no current smoking, moderate alcohol consumption) in adults without common cardiovascular risk factors such as elevated cholesterol (low-density lipoprotein, LDL, cholesterol >130 mg/dl), inflammation (C-reactive protein, CRP, >3.0 mg/l, or hypertension (blood pressure >140/90 mmHg).
Results: Of 11,841 participants, 14.9% were adherent to all five healthy habits. After controlling for age, race, and gender, individuals with lower LDL cholesterol (HR 6.33, 95% CI 2.80–14.30), low CRP (HR 3.48, 95% CI 2.23–5.41), or normal blood pressure (HR 2.87, 95% CI 1.58–5.20) and 0–1 healthy habits had significantly higher all-cause (shown) and cardiovascular mortality than people adhering to all five healthy habits. People without common risk factors and lacking only 1–2 of the healthy habits remained at higher risk of all-cause mortality.
Conclusions: People without a history of cardiovascular disease who lack common cardiovascular risk factors remain at significantly greater risk of cardiovascular and all-cause mortality if they do not adhere to a healthy lifestyle. Strategies to encourage adopting healthy lifestyles should be implemented among individuals across all risk levels.
MokdadAHMarksJSStroupDFGerberdingJL. Actual causes of death in the United States, 2000. JAMA2004; 291(10): 1238–1245.
2.
KingDEMainousAG3rdGeeseyM. Turning back the clock: adopting a healthy lifestyle in middle-age. Am J Med2007; 120(7): 598–603.
3.
KingDEMainousAG3rdGeeseyM. Adopting moderate alcohol consumption in middle age: subsequent cardiovascular events. Am J Med2008; 121(3): 201–206.
4.
KnoopsKTde GrootLCKromhoutDPerrinAEMoreiras-VarelaOMenottiA. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA2004; 292(12): 1433–1439.
5.
ChiuveSEMcCulloughMLSacksFMRimmEB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation2006; 114(2): 160–167.
6.
KingDEMainousAG3rdCarnemollaMEverettCJ. Adherence to healthy lifestyle habits in US adults, 1988–2006. Am J Med2009; 122(6): 528–534.
7.
Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey data. Hyattsville, MD: US Department of Health and Human Services. http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm [consulted July 2010].
8.
Clinical guidelines on the identification, evaluation, treatment of overweight and obesity in adults: the evidence report. The National Institutes of Health. Obes Res 1998; 6(2): 51S-209S.
9.
AinsworthBEHaskellWLLeonASJacobsDRJrMontoyeHJSallieJF. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc1993; 25(1): 71–80.
10.
American College of Sports Medicine position stand. Exercise for patients with coronary artery disease. Med Sci Sports Exerc1994; 26(3): i–v.
KizerJRMadiasCWilnerBVaughanCJMushlinAITrushinP. Relation of different measures of low-density lipoprotein cholesterol to risk of coronary artery disease and death in a meta-regression analysis of large-scale trials of statin therapy. Am J Cardiol2010; 105(9): 1289–1296.
13.
ChengVYWolakAGutsteinAGransarHWongNDDeyD. Low-density lipoprotein and noncalcified coronary plaque composition in patients with newly diagnosed coronary artery disease on computed tomographic angiography. Am J Cardiol2010; 105(6): 761–766.
14.
Third Report of the Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm [consulted September 2010].
15.
RidkerPM. Inflammatory biomarkers and risks of myocardial infarction, stroke, diabetes, and total mortality: implications for longevity. Nutr Rev2007; 65(12 Pt 2): S253–S259.
16.
ArantCBWesselTRRidkerPMOlsonMBReisSEDelia JohnsonB. Multimarker approach predicts adverse cardiovascular events in women evaluated for suspected ischemia: results from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation. Clin Cardiol2009; 32(5): 244–250.
17.
CummingsDMKingDEMainousAGGeeseyME. Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population. Eur J Cardiovasc Prev Rehabil2006; 13(2): 180–185.
18.
The Third National Health and Nutrition Examination Survey (NHANES III, 1988-94) Reference Manuals and Reports. National Center for Health Statistics. http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/main.pdf [consulted August 2011].
19.
MainousAG3rdEverettCJLiszkaHKingDEEganBM. Prehypertension and mortality in a nationally representative cohort. Am J Cardiol2004; 94(12): 1496–1500.
20.
RodgersAEzzatiMVander HoornSLopezADLinRBMurrayCJ. Comparative Risk Assessment Collaborating Group. Distribution of major health risks: Findings from the Global Burden of Disease study. PLoS Med2004; 1(1): e27–e27.
21.
HansenTWLiYBoggiaJThijsLRichartTStaessenJA. Predictive role of the nighttime blood pressure. Hypertension2011; 57(1): 3–10.
22.
ReevesMJRaffertyAP. Healthy lifestyle characteristics among adults in the United States, 2000. Arch Intern Med2005; 165(8): 854–857.
23.
Cholesterol Treatment Trialists’ (CTT) Collaborators, Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005; 366(9493): 1267–1278.
24.
KhawKTWarehamNBinghamSWelchALubenRDayN. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med2008; 5(1): e12–e12.
25.
van DamRMLiTSpiegelmanDFrancoOHHuFB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ2008; 337: a1440–a1440.
26.
MoscaLLinfanteAHBenjaminEJBerraKHayesSNWalshBW. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation2005; 111(4): 499–510.
27.
National Health and Nutrition Examination Survey. Frequency distribution for questions for NHANES DIQ190A, DIQ190B, and DIQ190C. Centers for Disease Control and Prevention and National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2007–2008/diq_e.htm [consulted June 2011].
28.
FillenbaumGGBurchettBMBlazerDG. Identifying a National Death Index match. Am J Epidemiol2009; 170(4): 515–518.
29.
YusufSHawkenSOunpuuSDansTAvezumALanasF. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case−control study. Lancet2004; 364(9438): 937–952.
30.
NöthlingsUFordESKrögerJBoeingH. Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition−Potsdam study*. J Diabetes2010; 2(2): 112–117.
31.
ChiuveSEFungTTRexrodeKMSpiegelmanDMansonJEStampferMJ. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA2011; 306(1): 62–69.
32.
GallSLJamrozikKBlizzardLDwyerTVennA. Healthy lifestyles and cardiovascular risk profiles in young Australian adults: the Childhood Determinants of Adult Health Study. Eur J Cardiovasc Prev Rehabil2009; 16(6): 684–689.
