Healthy lifestyle factors and incident heart disease and mortality in candidates for primary prevention with statin therapy

Abstract

Background: There are limited data on the use of healthy lifestyles among adults who are candidates for primary prevention of atherosclerotic cardiovascular disease (ASCVD) with statin therapy due to a 10-year predicted risk ≥7.5%. We determined the prevalence of healthy lifestyle factors and their association with incident ASCVD and all-cause mortality in the Reason for Geographic and Racial Differences in Stroke study participants (n=5709).

Methods: Lifestyle factors (non-obese waist circumference, physical activity ≥5 times-per-week, non-smoking, low saturated-fat-intake, highest Mediterranean diet score quartile) were assessed during an in-home examination and interviewer-administered questionnaires. Adjudicated incident ASCVD (nonfatal/fatal stroke, nonfatal myocardial infarction or coronary heart disease death) and all-cause mortality were identified through active participant follow-up.

Results: Overall, 5.1%, 28.9%, 36.9%, 21.7% and 7.5% had 0, 1, 2, 3, and ≥4 of the 5 healthy lifestyle factors studied. There were 377 incident ASCVD events (203 CHD events and 174 strokes) and 471 deaths during 5.8 and 6.0 median years of follow-up, respectively. ASCVD incidence rates (95% CI) per 1000-person-years associated with 0, 1, 2, 3 and ≥4 healthy lifestyles were 13.4 (7.3-19.5), 12.8 (10.4-15.2), 11.0 (9.0-12.9), 11.0 (8.3-13.7), and 8.7 (4.9-12.4), respectively. Mortality rates associated with 0, 1, 2, 3 and ≥4 healthy lifestyles were 20.6 (13.3-27.8), 15.9 (13.3-18.5), 13.1 (10.9-15.2), 12.6 (9.9-15.2) and 9.2 (5.3-13.2) per 1000-person-years, respectively. The use of more healthy lifestyles was associated with lower risks for ASCVD and mortality after multivariable adjustment.

Conclusion: Healthy lifestyles are underutilized among high-risk US adults and may substantially reduce their ASCVD risk.

Keywords: Atherosclerotic cardiovascular disease; Atherosclerotic cardiovascular disease risk; Cholesterol treatment guidelines; Healthy lifestyle; Mortality; Statins.

Figure 1.

Exclusion cascade for the analysis of healthy lifestyle factors with atherosclerotic cardiovascular disease and all-cause mortality in the REGARDS study (n=5,709). LDL-C: low-density lipoprotein cholesterol, ASCVD: atherosclerotic cardiovascular disease.

Figure 2.

Number of healthy lifestyle factors among participants with a 10-year predicted atherosclerotic cardiovascular disease risk ≥7.5% (n=5,709). ^aHealthy lifestyle factors include a non-obese waist circumference (men: <102 cm women: <88 cm), physical activity ≥5 times-per-week, nonsmoking, saturated fat intake <7.0% of daily calories and Mediterranean diet score ≥6.