title: Lifestyle Changes in Young Adulthood and Middle Age and Risk of Cardiovascular Disease and All-Cause Mortality: The Doetinchem Cohort Study.
abstract: BACKGROUND
  The associations between overall lifestyle profile and cardiovascular disease (CVD) and death have been mainly investigated in cross-sectional studies. The full benefits of a healthy lifestyle may therefore be underestimated, and the magnitude of benefits associated with changes in lifestyle remains unclear. We quantified the association of changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality.
  
  
  RESULTS
  Lifestyle factors (ie, diet, physical activity, smoking, alcohol consumption) and body mass index were assessed and dichotomized as healthy/unhealthy among 5263 adults ages 26 to 66 in 1993-1997 and 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were estimated to quantify associations of change in lifestyle with fatal/nonfatal CVD and all-cause mortality that occurred 8 to 15 years after 1998-2002. Independent of baseline lifestyles, each decrement in number of healthy lifestyle factors was, on average, associated with 35% higher risk of CVD (HR, 1.35; 95% CI, 1.12-1.63) and 37% higher risk of all-cause mortality (HR, 1.37; 95% CI, 1.10-1.70); no association was noted with increase in the number of healthy lifestyle factors (P>0.5). Individuals who maintained 4 to 5 healthy lifestyle factors had 2.5 times lower risk of CVD (HR, 0.43; 95% CI, 0.25-0.63) and all-cause mortality (HR, 0.40; 95% CI, 0.22-0.73) than those who maintained only 0 to 1 healthy lifestyle factor.
  
  
  CONCLUSIONS
  Our findings suggest that the benefits of healthy lifestyles may be easier lost than gained over a 5-year period. This underscores the need for efforts to promote maintenance of healthy lifestyles throughout the life course.
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (G.H., M.L., M.V.) Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (G.H., H.S., Y.T.S., M.V.).
authors.forename: Gerben
authors.initials: G
authors.lastname: Hulsegge
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (G.H., M.L., M.V.).
authors.forename: Moniek
authors.initials: M
authors.lastname: Looman
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (G.H., H.S., Y.T.S., M.V.).
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Smit
authors.affiliation: Institute for Minority Health Research, University of Illinois at Chicago Chicago, IL (M.L.D.) Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (M.L.D.).
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (G.H., H.S., Y.T.S., M.V.).
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (G.H., M.L., M.V.) Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (G.H., H.S., Y.T.S., M.V.).
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
mesh_terms: D000328:Adult; D000367:Age Factors; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000517:prevention & control; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D004032:Diet / Q000009:adverse effects; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009426:Netherlands; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D055815:Young Adult
keywords: all‐cause death; cardiovascular disease; lifestyle