title: Healthy lifestyle factors and incident heart disease and mortality in candidates for primary prevention with statin therapy.
abstract: BACKGROUND
  There are limited data on the use of healthy lifestyles among adults who are candidates for primary prevention of atherosclerotic cardiovascular disease (ASCVD) with statin therapy due to a 10-year predicted risk ≥7.5%. We determined the prevalence of healthy lifestyle factors and their association with incident ASCVD and all-cause mortality in the Reason for Geographic and Racial Differences in Stroke study participants (n=5709).
  
  
  METHODS
  Lifestyle factors (non-obese waist circumference, physical activity ≥5 times-per-week, non-smoking, low saturated-fat-intake, highest Mediterranean diet score quartile) were assessed during an in-home examination and interviewer-administered questionnaires. Adjudicated incident ASCVD (nonfatal/fatal stroke, nonfatal myocardial infarction or coronary heart disease death) and all-cause mortality were identified through active participant follow-up.
  
  
  RESULTS
  Overall, 5.1%, 28.9%, 36.9%, 21.7% and 7.5% had 0, 1, 2, 3, and ≥4 of the 5 healthy lifestyle factors studied. There were 377 incident ASCVD events (203 CHD events and 174 strokes) and 471 deaths during 5.8 and 6.0 median years of follow-up, respectively. ASCVD incidence rates (95% CI) per 1000-person-years associated with 0, 1, 2, 3 and ≥4 healthy lifestyles were 13.4 (7.3-19.5), 12.8 (10.4-15.2), 11.0 (9.0-12.9), 11.0 (8.3-13.7), and 8.7 (4.9-12.4), respectively. Mortality rates associated with 0, 1, 2, 3 and ≥4 healthy lifestyles were 20.6 (13.3-27.8), 15.9 (13.3-18.5), 13.1 (10.9-15.2), 12.6 (9.9-15.2) and 9.2 (5.3-13.2) per 1000-person-years, respectively. The use of more healthy lifestyles was associated with lower risks for ASCVD and mortality after multivariable adjustment.
  
  
  CONCLUSIONS
  Healthy lifestyles are underutilized among high-risk US adults and may substantially reduce their ASCVD risk.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Lisandro D
authors.initials: LD
authors.lastname: Colantonio
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: University of Vermont, Colchester, VT, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: pmuntner@uab.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D015331:Cohort Studies; D038441:Diet, Mediterranean; D002149:Energy Intake; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D000070497:Healthy Lifestyle; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011159:Population Surveillance; D011322:Primary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D055105:Waist Circumference
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Atherosclerotic cardiovascular disease; Atherosclerotic cardiovascular disease risk; Cholesterol treatment guidelines; Healthy lifestyle; Mortality; Statins