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Adhering to a Healthy Lifestyle Attenuates the Risk of Total Mortality Related to Cardiometabolic Diseases: A Prospective UK Biobank Cohort Study
31 Pages Posted: 15 Feb 2020
More...Abstract
Background: Cardiometabolic diseases (CMDs), including diabetes, coronary heart disease, and stroke, increase risk of mortality, but the extent to which this can be offset by adhering to a healthy lifestyle is unknown. We aimed to investigate the stratified and combined associations of CMDs status and lifestyle factors with total mortality.
Methods: Data for this prospective analysis was sourced from the UK Biobank with 356,666 participants aged 37 to 73 years between 2006 and 2010. Adherence to a healthy lifestyle was determined on the basis of four factors: non-smoker, healthy diet, body mass index <30 kg/m2, and regular physical activity. Cox proportional hazards models were used to calculate hazard ratios (HRs) and confidence intervals (CIs) of the associations of CMDs status and lifestyle factors with total mortality.
Results: During a median of 9.0 years of follow-up, a total of 10 849 death events occurred. The multivariate-adjusted HRs of mortality were 1.49 (1.41–1.57) for one, 2.41 (2.20–2.66) for two, and 3.97 (3.01–5.25) for three CMDs. In joint exposure analysis, compared with CMDs-free and a favorable lifestyle, the HRs of mortality were 2.43 (2.20-2.68) for patients with CMDs plus an unfavorable lifestyle and 1.64 (1.53-1.76) for those with CMDs plus a favorable lifestyle. A favorable lifestyle attenuates the CMDs-related risk of mortality by approximately 55%. The mortality risk of CMDs-free people but have unfavorable lifestyle was consistent with those who have over one CMDs but have favorable lifestyle. Furthermore, a favorable lifestyle was associated with a lower risk of mortality regardless of CMDs status.
Interpretation: CMDs are associated with higher risk of total mortality, and the potential effect of an increasing number of CMDs appears additive. Whereas, adherence to a healthy lifestyle attenuates the CMDs-related mortality risk by more than 50%. These findings highlight the potential of lifestyle interventions to reduce risk of mortality across entire populations, even in patients with CMDs.
Funding Statement: This study was supported by the National Natural Science Foundation of
China (91746205, 71910107004, 71673199). This research has been conducted using the UK Biobank Resource under the project number of 45676.
Declaration of Interests: The authors declare that they have no conflicts of interests.
Ethics Approval Statement: All participants provided written informed consent and the study was approved by the NHS National Research Ethics Service (Ref: 11/NW/0382).
Keywords: Lifestyle, cardiometabolic disease, mortality, cohort study
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