Lifestyle changes in young adulthood and middle age and risk of cardiovascular disease and all-cause mortality: the doetinchem cohort study

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. methods and 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. © 2016 the authors.