Lifestyle Changes in Young Adulthood and Middle Age and Risk of Cardiovascular Disease and All-Cause Mortality: The Doetinchem Cohort Study

Abstract

Background: The associations between overall lifestyle profile and cardiovascular disease (CVD) and death have been mainly investigated in cross-sectional studies. The full benefits of a healthy lifestyle may therefore be underestimated, and the magnitude of benefits associated with changes in lifestyle remains unclear. We quantified the association of changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality.

Methods and results: Lifestyle factors (ie, diet, physical activity, smoking, alcohol consumption) and body mass index were assessed and dichotomized as healthy/unhealthy among 5263 adults ages 26 to 66 in 1993-1997 and 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were estimated to quantify associations of change in lifestyle with fatal/nonfatal CVD and all-cause mortality that occurred 8 to 15 years after 1998-2002. Independent of baseline lifestyles, each decrement in number of healthy lifestyle factors was, on average, associated with 35% higher risk of CVD (HR, 1.35; 95% CI, 1.12-1.63) and 37% higher risk of all-cause mortality (HR, 1.37; 95% CI, 1.10-1.70); no association was noted with increase in the number of healthy lifestyle factors (P>0.5). Individuals who maintained 4 to 5 healthy lifestyle factors had 2.5 times lower risk of CVD (HR, 0.43; 95% CI, 0.25-0.63) and all-cause mortality (HR, 0.40; 95% CI, 0.22-0.73) than those who maintained only 0 to 1 healthy lifestyle factor.

Conclusions: Our findings suggest that the benefits of healthy lifestyles may be easier lost than gained over a 5-year period. This underscores the need for efforts to promote maintenance of healthy lifestyles throughout the life course.

Keywords: all‐cause death; cardiovascular disease; lifestyle.

Figure 1

Overview of baseline and 5‐year lifestyle profiles. The number of participants in each lifestyle profile represents the average number of participants of the 20 imputed data sets. The categories do not add up to 5263 because of rounding. CVD indicates cardiovascular disease.

Figure 2

Multivariable adjusted hazard ratios of incident total cardiovascular disease (A and B) and all‐cause mortality (C and D). For baseline lifestyle profiles (A and C)^† and 5‐year lifestyle profiles (B and D) including adults who maintained that same lifestyle profile (gray)^‡, improved (green)^§, or deteriorated (red)^║ during 5‐year follow‐up. *Statistically significant different from (sustained) unhealthy lifestyle profile, P<0.05. ^†Healthy lifestyle profile was defined as having 4 to 5 of the following healthy lifestyle factor: Mediterranean Diet Score ≥5, ≥3.5 hours per week spent on moderate‐to‐vigorous intensity physical activities, not currently smoking, moderate alcohol consumption, and a body mass index lower than 30 kg/m². Participants with moderately healthy lifestyle profile adhered to 2 to 3 healthy lifestyle factors and participants with an unhealthy lifestyle profile to 1 or less factors. ^‡Sustained: lifestyle profile remains steady over 5 years. ^§Improve: lifestyle profile improved over 5 years. ^║Deteriorate: lifestyle profile deteriorated over 5 years.