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

Abstract

Abstract Objectives Adherence to healthy lifestyle and pharmacological therapies represent two major approaches to chronic disease prevention. It remains unknown whether individuals who regularly use preventive medications still benefit from adherence to healthy lifestyle as those not using the medications. We aimed to examine the associations of healthy lifestyle with all-cause and cause-specific mortality among regular users and nonusers of major preventive medications. Methods We prospectively assessed lifestyles and regular use of aspirin, antihypertensives, and lipid-lowering medications through biennial questionnaires among 79,043 women in the Nurses’ Health Study (1988–2014) and 39,544 men in the Health Professionals Follow-up Study (1986–2014). A healthy lifestyle score (ranging 0–5) was defined based on body mass index of ≥18.5 and < 27.5 kg/m2, never smoking, moderate-to-vigorous intensity activity for ≥30 minutes/day, alternate healthy eating index in the upper 40%, and light-to-moderate alcohol intake. We calculated multivariable hazard ratios (HRs) and population-attributable risks (PARs) of death from any cause, cardiovascular disease (CVD), cancer, and other causes in relation to healthy lifestyle according to medication use. Results During a median of 26 years of follow-up, 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 one-unit increment; 95% CI, 0.81–0.82) and nonusers (HR, 0.81 per one-unit increment; 95% CI, 0.79–0.83) (P-interaction = 0.54). The fraction of premature deaths that may potentially be prevented by adherence to all 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 CVD mortality, 38% (95% CI, 28–46%) and 33% (95% CI, 14–49%) for cancer mortality, 33% (95% CI, 25–41%) and 38% (95% CI, 20–54%) for other mortality, respectively. Conclusions Adherence to healthy lifestyle confers substantial benefit for prevention of premature death among both regular users and nonusers of preventive medications. Adherence to healthy lifestyle remains important even among individuals regularly using preventive medications. Funding Sources American Cancer Society and NIH.