Combined lifestyle factors and cardiovascular disease mortality in Chinese men and women: the Singapore Chinese health study

Abstract

Background: Lifestyle factors directly influence cardiovascular disease (CVD) risk, yet little research has examined the association of combined lifestyle factors with CVD mortality, especially in Asian populations.

Methods and results: We examined the association of 6 combined lifestyle factors (dietary pattern, physical activity, alcohol intake, usual sleep, smoking status, and body mass index) with CVD mortality in 50 466 (44 056 without a history of diabetes mellitus, CVD, or cancer and 6410 with diabetes mellitus or history of clinical CVD) Chinese men and women in Singapore who were 45 to 74 years of age during enrollment in the Singapore Chinese Health Study in 1993 to 1998 and followed up through 2009. Each lifestyle factor was independently associated with CVD mortality. When combined, there was a strong, monotonic decrease in age- and sex-standardized CVD mortality rates with an increasing number of protective lifestyle factors. Relative to participants with no protective lifestyle factors, the hazard ratios of CVD mortality for 1, 2, 3, 4, and 5 to 6 protective lifestyle factors were 0.60 (95% confidence interval, 0.45-0.84), 0.50 (95% confidence interval, 0.38-0.67), 0.40 (95% confidence interval, 0.30-0.53), 0.32 (95% confidence interval, 0.24-0.43), and 0.24 (95% confidence interval, 0.17-0.34), respectively, among those without a history of diabetes mellitus, CVD, or cancer (P for trend <0.0001). A parallel graded inverse association was observed in participants with a history of CVD or diabetes mellitus at baseline. Results were consistent for coronary heart disease and cerebrovascular disease mortality.

Conclusion: An increasing number of protective lifestyle factors is associated with a marked decreased risk of coronary heart disease, cerebrovascular disease, and overall CVD mortality in Chinese men and women.

Figure

Hazard ratios (HRs) and 95% confidence intervals (CIs) of cardiovascular disease (CVD) mortality (International Classification of Disease, version 9, codes 390-459) according to number of protective lifestyle factors in individuals with a history of clinical CVD or diabetes mellitus at enrollment (n=6410; CVD deaths, 1184; P for trend <0.0001). Respective n (CVD deaths) for 0/1, 2, 3, 4, and 5 to 6 low-risk lifestyle factors: 358 (104), 1602 (370), 2605 (460), 1451 (203), and 394 (47). Age- and sex-standardized CVD mortality rates across categories: 311, 214, 149, 113, and 94.