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Impact of combined healthy lifestyle factors on survival in an adult general population and in high‐risk groups: prospective results from the Moli‐sani Study
Author(s) -
Bonaccio M.,
Di Castelnuovo A.,
Costanzo S.,
De Curtis A.,
Persichillo M.,
Cerletti C.,
Donati M. B.,
Gaetano G.,
Iacoviello L.
Publication year - 2019
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12907
Subject(s) - medicine , hazard ratio , proportional hazards model , population , confidence interval , diabetes mellitus , mediterranean diet , prospective cohort study , abdominal obesity , obesity , lower risk , disease , demography , gerontology , environmental health , metabolic syndrome , endocrinology , sociology
Background There is poor knowledge on the association between combined lifestyles with mortality risk among individuals at high risk, and little is known on the biological mechanisms that could be on the pathway. Methods Longitudinal analysis on 22 839 individuals from the Moli‐sani Study (Italy, 2005–2010). Among them, we identified 5200 elderly individuals (≥65 year), 2127 subjects with diabetes and 1180 with cardiovascular disease ( CVD ) at baseline. A healthy lifestyle score ( HLS ) was calculated, allocating 1 point for each of the following: abstention from smoking; adherence to Mediterranean diet; physical activity; absence of abdominal obesity. Hazard ratios ( HR ) with 95% confidence intervals (95% CI ) were calculated by multivariable Cox regression and competing risk models. Results During 8.2 years of follow‐up, 1237 deaths occurred. In the general population, adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of all‐cause ( HR = 0.53; 95% CI :0.39–0.72), CVD ( HR = 0.54; 0.32–0.91), cancer ( HR = 0.62; 0.39–1.00) and mortality from other causes ( HR = 0.39; 0.19–0.81). A 1‐point increase in HLS was associated with 20%, 22% and 24% lower risk of total mortality among the elderly, in subjects with diabetes or CVD , respectively. Traditional (e.g. blood lipids), inflammatory (e.g. C‐reactive protein) and novel biomarkers (e.g. markers of cardiac damage) accounted for up to 24% of the association of HLS with all‐cause mortality risk in the general population. Conclusions The impact of combined four healthy lifestyles on survival was considerable, both in the general population and among high‐risk subgroups. Inflammatory and novel biomarkers of CVD risk explained a substantial proportion of this association.