Healthy lifestyles and the incidence risk and time of carotid plaque

The association between lifestyles and carotid plaque has shown heterogeneity in results across studies, which may be limited by sample size or population characteristics. In addition, there is a lack of evidence on how long healthy lifestyles delay plaque development and on the metabolic factors that are likely to mediate these associations. A study investigated the impact of multiple healthy lifestyles on the risk and time of carotid plaque incidence in the early stages of atherosclerotic cardiovascular disease (CVD), and to identify the metabolic factors mediating this association.
Data from 43,651 participants with moderate or high risk for CVD from the ChinaHEART cohort (2014-2021) were analysed, excluding those with prior carotid plaque or CVD, or incomplete data. The association between non-smoking, moderate alcohol intake, sufficient leisure time physical activity (LTPA), and a healthy diet and incident carotid plaque was analysed using odds ratios (ORs) and time ratios (TRs) from repeated carotid ultrasounds, and calculated the mediation effects of metabolic factors.
During a mean follow-up period of 1.74 ± 0.43 years, incident carotid plaque was documented in 14,698 participants (33.7%). Non-smoking (OR: 0.86 [0.80, 0.91]), moderate alcohol use (0.90 [0.84, 0.97]), sufficient LTPA (0.94 [0.90, 0.99]), and a healthy diet (0.90 [0.84, 0.97]) each independently lowered the risk of carotid plaque, with TRs indicating delays in plaque onset (1.01 to 1.06). Compliance with all four healthy lifestyles significantly reduced plaque risk (OR: 0.64) and delayed onset (TR: 1.16), with stronger effects in the high-risk group. Metabolic factors varied in their mediation of lifestyle effects on plaque incidence.
Healthy lifestyles are associated with a lower risk and later onset of carotid plaque, suggesting that a primary prevention strategy focusing on multiple healthy behaviours, especially in high-risk individuals, may provide significant benefits.
Source: Lin C, Zhang X, Fang X, He W, Zhang X, Wu C, Bai X, Yang Y, Cui J, Xu W, Song L, Yang H, Zhang Y, Gao Y, Zhang H, Li X. Healthy lifestyles and the incidence risk and time of carotid plaque: a nationwide cohort study. BMC Public Health. 2025 Jul 15;25(1):2462.