title: Comparison of lifestyle-based and traditional cardiovascular disease prediction in a multiethnic cohort of nonsmoking women.
abstract: BACKGROUND
  Healthy levels of lifestyle factors can reduce the risk of cardiovascular disease. However, except for smoking status, often considered a traditional risk factor, their effect on cardiovascular risk prediction is unclear.
  
  
  RESULTS
  We used a case-cohort design of postmenopausal nonsmokers in the multiethnic Women's Health Initiative Observational Study (1587 cases and 1808 subcohort participants) with a median follow-up of 10 years in noncases. Compared with nonsmokers with no other healthy lifestyle factors (healthy diet, recreational physical activity, moderate alcohol use, and low adiposity), the risk of cardiovascular disease was lower for each additional factor (hazard ratio for trend, 0.82; 95% confidence interval, 0.76-0.89), with a 45% reduction in risk with all factors (95% confidence interval, 0.36-0.84). When lifestyle factors were added to traditional risk factor models (variables from the Pooled Cohort and Reynolds risk scores), only recreational physical activity remained independently associated with the risk of cardiovascular disease. The addition of detailed lifestyle measures to traditional models showed a change in the integrated discrimination improvement and continuous net reclassification improvement (P<0.01 for both) but had little impact on more clinically relevant risk stratification measures.
  
  
  CONCLUSIONS
  Although lifestyle factors have important effects on cardiovascular disease risk factors and subsequent risk, their addition to established cardiovascular disease risk models does not result in clear improvement in overall prediction.
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.). npaynter@partners.org.
authors.forename: Nina P
authors.initials: NP
authors.lastname: Paynter
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Robinson
authors.affiliation: From Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.P.P., J.E.M., P.MR., N.R.C.); School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (M.J.L.); George Washington University School of Medicine, Washington, DC (L.W.M.); Emory University School of Medicine, Atlanta, GA (L.S.P.); and College of Public Health, University of Iowa, Iowa City (J.G.R.).
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Cook
mesh_terms: D050154:Adiposity; D000368:Aged; D000428:Alcohol Drinking / Q000208:ethnology; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009043:Motor Activity; D017698:Postmenopause; D011237:Predictive Value of Tests; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking; D044465:White People / Q000706:statistics & numerical data
keywords: cardiovascular diseases; lifestyle; primary prevention; risk assessment