Healthy Lifestyle for Prevention of Premature Death Among Users and Nonusers of Common Preventive Medications: A Prospective Study in 2 US Cohorts

Abstract

Background It remains unknown whether individuals who regularly use preventive medications receive the same benefit from healthy lifestyle as those who do not use medications. We aimed to examine the associations of healthy lifestyle with mortality according to use of major preventive medications, including aspirin, antihypertensives, and lipid-lowering medications. Methods and Results Among 79 043 women in the Nurses' Health Study (1988-2014) and 39 544 men in the Health Professionals Follow-up Study (1986-2014), we defined a healthy lifestyle score based on body mass index, smoking, physical activity, diet, and alcohol intake. We estimated multivariable hazard ratios (HRs) and population-attributable risks of death from any cause, cardiovascular disease, cancer, and other causes in relation to healthy lifestyle according to medication use. We documented 35 195 deaths. A similar association of healthy lifestyle score with lower all-cause mortality was observed among medication users (HR, 0.82 per unit increment; 95% CI, 0.81-0.82) and nonusers (HR, 0.81; 95% CI, 0.79-0.83) (P interaction=0.54). The fraction of premature deaths that might be prevented by adherence to the 5 healthy lifestyle factors among medication users and nonusers was 38% (95% CI, 32%-42%) and 40% (95% CI, 29%-50%) for all-cause mortality, 37% (95% CI, 27%-46%) and 45% (95% CI, 18%-66%) for cardiovascular disease mortality, and 38% (95% CI, 28%-46%) and 33% (95% CI, 14%-49%) for cancer mortality, respectively. Conclusions Adherence to a healthy lifestyle confers substantial benefit for prevention of premature death among both regular users and nonusers of preventive medications. Adherence to a healthy lifestyle remains important even among individuals regularly using preventive medications.

Keywords: lifestyle; mortality; nutrition; preventive medication; primary prevention.

Figure 1

Associations of body mass index (A), smoking (B), alcohol intake (C), physical activity (D), and the Alternate Healthy Eating Index score (E) with all‐cause mortality according to regular use of common preventive medications. Common preventive medications included aspirin, antihypertensives, and lipid‐lowering medications; regular medication use was defined as use ≥2 tablets per week or ≥2 times per week. Multivariable Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% CIs while adjusting for age, calendar period, ethnicity, current multivitamin use, family history of diabetes mellitus, myocardial infarction, or cancer; menopausal status and hormone use (women only); and the other 4 of the 5 lifestyle factors. Error bars indicate 95% CIs.

Figure 2

Association of healthy lifestyle score with all‐cause mortality according to regular use of common preventive medications. Healthy lifestyle score (range, 0–5) was defined as the number of the 5 healthy lifestyle factors: healthy body weight (body mass index, ≥18.5 and <27.5 kg/m²), never smoking, light to moderate alcohol intake (>0 and <1 drink [14 g alcohol] per day for women, >0 and <2 drink [28 g alcohol] per day for men), physical active (≥30 min/d of moderate to vigorous intensity activity), and high‐quality diet (upper 40% of Alternate Healthy Eating Index score). Common preventive medications included aspirin, antihypertensives, and lipid‐lowering medications; regular medication use was defined as use ≥2 tablets per week or ≥2 times per week. Multivariable Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% CIs while adjusting for age, calendar period, ethnicity, current multivitamin use, family history of diabetes mellitus, myocardial infarction, or cancer; and menopausal status and hormone use (women only). Error bars indicate 95% CIs.

Figure 3

Prevalence and population‐attributable risk (PAR) (95% CI) estimates of the 5 healthy lifestyle factors for all‐cause and cause‐specific mortality among medication users by use duration and medication type. The 5 healthy lifestyles included healthy body weight (body mass index, ≥18.5 and <27.5 kg/m²), never smoking, light to moderate alcohol intake (>0 and <1 drink [14 g alcohol] per day for women, >0 and <2 drink [28 g alcohol] per day for men), physical active (≥30 min/d of moderate to vigorous intensity activity), and high‐quality diet (upper 40% of Alternate Healthy Eating Index score). Regular medication use was defined as use ≥2 tablets per week or ≥2 times per week. PARs and 95% CIs were calculated while adjusting for age, calendar period, ethnicity, current multivitamin use, family history of diabetes mellitus, myocardial infarction, or cancer; and menopausal status and hormone use (women only). Error bars indicate 95% CIs. CVD indicates cardiovascular disease.