Abstract 16923: Healthy Lifestyle is Inversely Associated With All-Cause Mortality Irrespective of Medication Burden

Abstract

Introduction: The benefits of a healthy lifestyle in the context of a high disease and medication burden are not clear. Hypothesis: Healthy lifestyle is inversely associated with all-cause mortality among adults with high medication burden. Methods: We examined participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Exposure variables were 4 healthy behaviors: adherence to a Mediterranean diet, physical activity, smoking abstinence, and sedentary lifestyle avoidance (low TV time). Each behavior was scored from 0-2, where 0 indicated low adherence and 2 indicated high adherence. We also examined a cumulative Health Behavior Score (HBS) based on the sum of individual behavior scores (range 0-8). The main outcome was all-cause mortality. To examine the association between each behavior and mortality, we estimated Cox proportional hazards models for each medication burden stratum (no polypharmacy: 0-4 medications at baseline; polypharmacy: 5-9; hyperpolypharmacy: ≥ 10), adjusting for socio-demographics, health status, comorbid conditions, and medication adherence. Results: Among 20,417 participants (9.8 ± 3.8 years followup), mean age was 64.8 ± 9.2 years, and 56% were women. At baseline, 44% had no polypharmacy, 39% had polypharmacy, and 17% had hyperpolypharmacy. Mortality increased with increasing medication burden (no polypharmacy: 19.1%; polypharmacy: 29.7%; hyperpolypharmacy: 41.3%). The highest score for each behavior was inversely associated with all-cause mortality in all 3 strata. The highest HBS for each stratum conferred substantial benefit (no polypharmacy: HR 0.52 (95% CI 0.45-0.61); polypharmacy: HR 0.55 (95% CI 0.49-0.63); hyperpolypharmacy HR 0.69 (95% CI 0.58-0.82)) (Table). Conclusions: Healthy lifestyle was inversely associated with all-cause mortality irrespective of medication burden, supporting the value of healthy lifestyle counseling even among adults with high medication burden.