Joint associations of multiple healthy lifestyles with the risk of cardiovascular disease

Cardiovascular disease (CVD) is a major contributor to disability and the leading cause of global mortality. A population-based prospective cohort study examined the combined impact of multiple lifestyle factors on CVD risk and examined the differences in the relationships across sociodemographic groups. Researchers used data from the UK Biobank. Exposures included seven lifestyle behaviours (smoking, physical activity, alcohol consumption, diet, sleep duration, sedentary behaviour, and social connection) and combined multiple behaviours. Moderate alcohol consumption was defined as never drinking or consuming 0–14 g/day for women and 0–28 g/day for men, according to the U.S. Dietary Guidelines for Americans. The lifestyle score was subsequently categorized as favourable (5 to 7 healthy lifestyle factors), intermediate (2 to 4 healthy lifestyle factors), and unfavourable (0 to 1 healthy lifestyle factor) lifestyle classes. Hazard ratios (HRs) for incident CVD and its subtypes were estimated.
The study showed a significant association of favourable lifestyle with incident CVD (HR = 0.58, 95% CI: 0.54-0.63), myocardial infarction (HR = 0.58, 95% CI: 0.54-0.64), and ischemic stroke (HR = 0.56, 95% CI: 0.48-0.65). Similarly, there was a significant association of intermediate lifestyle with incident CVD (HR = 0.69, 95% CI: 0.64-0.75), myocardial infarction (HR = 0.70, 95% CI: 0.64-0.77), and ischemic stroke (HR = 0.66, 95% CI: 0.57-0.77). The protection effect of lifestyle was more pronounced in the midlife group, females, and those individuals with high Townsend deprivation index levels. Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of CVD and subtypes. Lifestyle modification through multifactorial approaches should be prioritized for preventing and delaying onset of CVD.
Source: Zewen Yang, Yujie Zhao, Jia You, Cheryl Carcel, Yuzhu Li, Shitong Xiang, Jujiao Kang, Wei Zhang, Zeyu Li, Yongwei Zhang, Lijun Wang, Pengfei Xing, Pengfei Yang, Jianfeng Feng, Jianmin Liu, Yu Zhou, Wei Cheng, Yang Zhao, Joint associations of multiple healthy lifestyles with the risk of cardiovascular disease: a prospective cohort study of UK Biobank, European Journal of Public Health, 2026;ckaf110.