Poor lifestyle trajectory scores, comorbidities increase ischemic heart disease risk
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A decline in lifestyle trajectory over time is associated with increased risk for incident ischemic heart disease, according to a study published in European Journal of Preventive Cardiology.
“Relevant policies and regulations to ban smoking, providing activity-friendly environment, fat restriction and so on, are critical to prevent ischemic heart disease,” Yinyan Gao, of Xiangya School of Public Health at Central South University in Changsha, China, and colleagues wrote. “Meanwhile, our findings also suggested that the improvement of lifestyle, independent of the baseline level, could gain a reduced risk of incident ischemic heart disease.”
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In a large prospective cohort study, Gao and colleagues collected data from the UK Biobank’s baseline assessment between 2006 and 2010 to examine 352,251 participants (mean age, 55.9 years; 54.5% women) for an unhealthy lifestyle score construction and 29,164 participants (mean age, 55.4 years; 51.2% women) for a lifestyle trajectory analysis. Participants had no history of ischemic heart disease and completed at least one follow-up assessment. The median follow-up period was 11.3 years and 7.3 years for unhealthy lifestyle score and lifestyle trajectory analysis, respectively.
Lifestyle scores were determined by smoking status, physical activity, diet, BMI and sleep duration. For each lifestyle factor, classifications included poor, ideal or maintain. Meanwhile, lifestyle trajectory analyses compared baseline lifestyle scores with subsequent lifestyle trajectory into categories labeled declining (HR 1.02), improving (HR 0.98) or maintaining (HR between 0.98 and 1.02).
Following the calculations for both lifestyle scores and lifestyle trajectories, researchers merged the categories to improve statistical power. The merged categories were labeled ideal-maintain, ideal-decline, intermediate-maintain, intermediate-improve, intermediate-decline, poor-maintain, poor-improve and poor-decline.
Researchers found that participants had an increased risk for ischemic heart disease with every unit of increase in unhealthy lifestyle trajectory (HR = 1.08; 95% CI, 0.99-1.17). In addition, the association was highest among participants with comorbidities like hypertension (HR = 1.13; 95% CI, 1.03-1.24; P = .013), diabetes (HR = 1.23; 95% CI, 0.96-1.58; P = .097) or hyperlipidemia (HR = 1.09; 95% CI, 0.97-1.22; P = .166).
Participants also faced increased ischemic heart disease risk compared with the ideal-maintain group if they were in the intermediate-maintain (HR = 1.3; 95% CI, 1.07-1.58), poor-maintain (HR = 1.52; 95% CI, 1.23-1.88), intermediate-improve (HR = 1.25; 95% CI, 0.93-1.68), poor-improve (HR = 1.48; 95% CI, 1.17-1.88), intermediate-decline (HR = 1.46; 95% CI, 1.08-1.99) and poor-decline (HR = 1.77; 95% CI, 1.21-2.59) groups.
“Public health policies need to take initiatives conducive to changing to a healthier lifestyle, and to refine and promote guidelines on optimal lifestyle behavior recommendations for specific populations,” Gao and colleagues wrote.
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