Protective Effects of Healthy Lifestyle Scores Against the Risk of Cardiovascular Diseases: A Representative Cohort Study from Taiwan

Abstract

Background: The protective effect of different healthy lifestyle scores against a cardiovascular disease (CVD) risk has been reported previously although a comparison of the predictive performance is lacking. We compared the performance measures of CVD risk from different healthy lifestyle scores among adult Taiwanese participants. Methods: We conducted a nationwide prospective cohort study of 6042 participants (median age 43 years, 50.2% women) in Taiwan’s Hypertensive, Hyperglycemia and Hyperlipidemia Survey, 2002, who did not have CVD at the baseline evaluation. The simple and weighted Taiwan healthy lifestyle scores were defined as a combination of normal body mass index, Mediterranean diet, adequately physical activity, not smoking and regular healthy drinking, and each dichotomous lifestyle factor. The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) have recommended lifestyle interventions and adherence to Life's Simple 7, and participants were assigned to four groups based on lifestyle scores to evaluate the incidence of cardiovascular events. Results: During a median 14.3 years follow-up period, 520 participants developed CVD events. In multivariate-adjusted Cox proportional hazard models, adherence to the highest category, compared with the lowest one, on the simple and weighted Taiwan lifestyle score showed hazard ratios of 0.43 and 0.44 (95% confidence interval [CI] 0.2–0.94 and 0.28–0.68, respectively) were significant. Age was a significant effect modifier for the protective effect of healthy lifestyle scores on CVD risk. When the simple and weighted Taiwan healthy lifestyle scores were added to the classical model, the Harrell C-statistic increased from 0.85 to 0.86 (95% CI 0.84–087; Pdiff=0.02) in both lifestyle scores. The performance measures by integrated discriminative improvement showed a significant increase after the addition of the simple and weighted Taiwan healthy lifestyle score (integrated discriminative improvement: 0.51, 95% CI 0.16–0.86, p=0.002, and 0.38, 95% CI 0.01,0.74, p=0.021, respectively). Conclusions: Healthy lifestyle scores had an inverse association with CVD risk, and the reduction of CVD risk was greater in young adults than in the older adults. Further investigations to study the mechanism of the role of lifestyle interventions in CVD prevention are warranted. Funding Statement: The authors have no funding to report. Declaration of Interests: All other authors have no potential conflicts of interest relevant to this article in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Ethics Approval Statement: Informed consent was obtained from each participant. The protocol was reviewed and approved by the Research Ethics Committee of National Taiwan University Hospital.