Adherence to Healthy Lifestyle and Cardiovascular Diseases in the Chinese Population

Abstract

Background: Adherence to a combination of healthy lifestyle factors has been related to a considerable reduction of cardiovascular risk in white populations; however, little is known whether such associations persist in nonwhite populations like the Asian population.

Objectives: This study aimed to examine the associations of a combination of modifiable, healthy lifestyle factors with the risks of ischemic cardiovascular diseases and estimate the proportion of diseases that could potentially be prevented by adherence to these healthy lifestyle patterns.

Methods: This study examined the associations of 6 lifestyle factors with ischemic heart disease and ischemic stroke (IS) in the China Kadoorie Biobank of 461,211 participants 30 to 79 years of age who did not have cardiovascular diseases, cancer, or diabetes at baseline. Low-risk lifestyle factors were defined as nonsmoking status or having stopped smoking for reasons other than illness, alcohol consumption of <30 g/day, a median or higher level of physical activity, a diet rich in vegetables and fruits and limited in red meat, a body mass index of 18.5 to 23.9 kg/m², and a waist-to-hip ratio <0.90 for men and <0.85 for women.

Results: During a median of 7.2 years (3.3 million person-years) of follow-up, this study documented 3,331 incident major coronary events (MCE) and 19,348 incident ISs. In multivariable-adjusted analyses, current nonsmoking status, light to moderate alcohol consumption, high physical activity, a diet rich in vegetables and fruits and limited in red meat, and low adiposity were independently associated with reduced risks of MCE and IS. Compared with participants without any low-risk factors, the hazard ratio for participants with ≥4 low-risk factors was 0.42 (95% confidence interval: 0.34 to 0.52) for MCE and 0.61 (95% confidence interval: 0.56 to 0.66) for IS. Approximately 67.9% (95% confidence interval: 46.5% to 81.9%) of the MCE and 39.1% (95% confidence interval: 26.4% to 50.4%) of the IS cases were attributable to poor adherence to healthy lifestyle.

Conclusions: Adherence to healthy lifestyle may substantially lower the burden of cardiovascular diseases in Chinese.

Keywords: cardiovascular diseases; cohort studies; health behavior; lifestyle.

Figure 1. Multivariable-adjusted HRs (95% CIs) for incident ischemic cardiovascular diseases by number of low-risk lifestyle factors among 461,211 participants

HR indicates hazard ratio; CI, confidence interval; and PYs, person-years. Horizontal lines represent 95% CI. “n” in parentheses indicates the number of new cases. Multivariable model was adjusted for age, sex, education, marital status, family histories of heart attack or stroke, and prevalent hypertension at baseline.

Central Illustration. Multivariable-adjusted PARs% (95% CIs) for incident ischemic cardiovascular diseases by specific combination of low-risk lifestyle factors among 461,211 participants

PAR% indicates population attributable risk percent; CI, confidence interval; BMI, body mass index; and WHR, waist-to-hip ratio. Specific combinations of low-risk lifestyle factors are: 3 lifestyle factors indicating smoking, physical activity, and dietary pattern; 4 factors additionally including BMI; 5 factors additionally including WHR; 6 factors additionally including alcohol consumption. Multivariable model was adjusted for age, sex, education, marital status, family histories of heart attack or stroke, and prevalent hypertension at baseline. All six lifestyle factors were included simultaneously in the same model.