title: Low-risk lifestyle, coronary calcium, cardiovascular events, and mortality: results from MESA.
abstract: Unhealthy lifestyle habits are a major contributor to coronary artery disease. The purpose of the present study was to investigate the associations of smoking, weight maintenance, physical activity, and diet with coronary calcium, cardiovascular events, and mortality. US participants who were 44-84 years of age (n = 6,229) were followed in the Multi-Ethnic Study of Atherosclerosis from 2000 to 2010. A lifestyle score ranging from 0 to 4 was created using diet, exercise, body mass index, and smoking status. Coronary calcium was measured at baseline and a mean of 3.1 (standard deviation, 1.3) years later to assess calcium progression. Participants who experienced coronary events or died were followed for a median of 7.6 (standard deviation, 1.5) years. Participants with lifestyle scores of 1, 2, 3, and 4 were found to have mean adjusted annual calcium progressions that were 3.5 (95% confidence interval (CI): 0.0, 7.0), 4.2 (95% CI: 0.6, 7.9), 6.8 (95% CI: 2.0, 11.5), and 11.1 (95% CI: 2.2, 20.1) points per year slower, respectively, relative to the reference group (P = 0.003). Unadjusted hazard ratios for death by lifestyle score were as follows: for a score of 1, the hazard ratio was 0.79 (95% CI: 0.61, 1.03); for a score of 2, the hazard ratio was 0.61 (95% CI: 0.46, 0.81); for a score of 3, the hazard ratio was 0.49 (95% CI: 0.32, 0.75); and for a score of 4, the hazard ratio was 0.19 (95% CI: 0.05, 0.75) (P < 0.001 by log-rank test). In conclusion, a combination of regular exercise, healthy diet, smoking avoidance, and weight maintenance was associated with lower coronary calcium incidence, slower calcium progression, and lower all-cause mortality over 7.6 years.
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, 600 N.Wolfe St, Baltimore, MD 21287, USA. hahmed2@jhmi.edu
authors.forename: Haitham M
authors.initials: HM
authors.lastname: Ahmed
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rivera
authors.forename: Arthur
authors.initials: A
authors.lastname: Agatston
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
authors.forename: Susan
authors.initials: S
authors.lastname: Lakoski
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D002114:Calcinosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
keywords: CT and MRI; coronary artery disease; diet; epidemiology; exercise; primary prevention; risk factors; weight reduction