Impact of a comprehensive healthy lifestyle score on a broad spectrum of cardiometabolic and related diseases and its incremental value for risk prediction based on the UK biobank database

Key Details

Cardiometabolic and related diseases (CMDs) represent a major global disease burden. While traditional risk factors are well-established, the role of lifestyle factors in primary prevention has not been sufficiently studied. This study analyzed data from 148,155 participants in the UK Biobank without baseline CMDs. Cox proportional hazards models were used to assess the impact of healthy lifestyle factors (non-current smoking, non-excessive drinking, regular physical activity, healthy diet, and healthy sleep) on 11 types of CMDs (coronary heart disease, type 2 diabetes, atrial fibrillation, hypertension, stroke, heart failure, Alzheimer's disease, non-alcoholic fatty liver disease, valvular heart disease, cardiomyopathy, and pulmonary hypertension). Participants were categorized into four groups based on weighted lifestyle scores. Improvements in predictive models after incorporating lifestyle factors were evaluated. Most individual healthy lifestyle factors were associated with a lower risk of CMDs, while regular physical activity was not independently associated with composite CMD risk in the fully adjusted model; healthy sleep contributed the largest weight to the composite lifestyle score (β = 0.342). Adhering to a healthier lifestyle demonstrated a significant and dose-response association with a reduced risk of composite CMDs. In the fully adjusted model, compared to the "very unhealthy" group, the "very healthy" group exhibited a significantly lower risk of developing CMDs (HR: 0.70, 95% CI: 0.67-0.74). Similar inverse associations were observed across several individual CMDs, with the strongest association observed for pulmonary hypertension (HR: 0.34, 95% CI: 0.24-0.50). Incorporating the lifestyle score into traditional risk models was associated with modest improvement in predictive performance. The findings were generally consistent across subgroups and sensitivity analyses. These findings suggest that adherence to a comprehensive healthy lifestyle, including adequate sleep, is associated with reduced risk of various CMDs and may improve risk stratification. The particularly strong association observed for pulmonary hypertension also supports further investigation of lifestyle patterns across a broader range of cardiometabolic and related conditions. Not applicable.

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• Impact of a comprehensive healthy lifestyle score on a broad spectrum of cardiometabolic and related diseases and its incremental value for risk prediction based on the UK biobank database.