Declined lifestyle trajectory linked to risk of ischemic heart disease: Study

"People with diabetes, hyperlipidemia or hypertension were more predisposed to the impact of lifestyle change." Yinyan Gao, Xiangya School of Public Health, Central South University, Changsha, China, and colleagues wrote in their study. "Relevant regulations and policies to ban smoking, fat restriction, and providing an activity-friendly environment are important for preventing heart disease."

"Meanwhile, our findings also indicate that the improvement of lifestyle, independent of the baseline level, could lead to a reduced risk of incident ischemic heart disease," they added.

The study included 29,164 participants in the UK Biobank having at least one follow-up assessment and free of IHD at the last follow-up assessment. A weighted unhealthy lifestyle score was constructed though summing five lifestyle factors (physical activity, sleep duration, BMI, diet, and smoking). Lifestyle was assessed at baseline from 2006-2009, the first follow-up assessment from 2012-2013 and the second follow-up assessment since 2014, and was used to derive the trajectories of each individual. The creation of joint categories was done by cross-classifying three baseline lifestyle categories (poor, intermediate and ideal) with three lifestyle trajectory categories (decline, maintain, and improve).

The study led to the following findings:

• During a median follow-up period of 4.2 years, 868 IHD events were recorded.
• The hazard ratio (HR) of incident IHD associated with per unit increase in unhealthy lifestyle trajectory was 1.08.
• Subgroup analyses indicated such association was stronger among individuals with hypertension (HR: 1.13), diabetes (HR: 1.23) or hyperlipidemia (HR: 1.09).
• Compared with participants consistently adhering to an ideal lifestyle (ideal-maintain), the HRs of incident IHD were: 1.30 (1.07-1.58) for intermediate-maintain, 1.52 (1.23-1.88) for poor-maintain, 1.25 (0.93-1.68) for intermedia-improve, 1.48 (1.17-1.88) for poor-improve, 1.46 (1.08-1.99) for intermedia-decline and 1.77 (1.21-2.59) for poor-decline.

To conclude, the researchers found an increased risk of incident ischemic heart disease with a declined lifestyle trajectory, regardless of baseline lifestyle levels. People with diabetes, hypertension, or hyperlipidemia were more predisposed to the impact of lifestyle change.

"Public health policies need to take initiatives favorable to changing to a healthier lifestyle, and to refine and promote guidelines on optimal lifestyle; behavior recommendations for specific people," the team wrote.

Reference:

Yinyan Gao, Yancong Chen, Mingyue Hu, Jinlu Song, Zixuan Zhang, Hui Sun, Jiali Wang, Yijuan Lin, Irene XY Wu, Lifestyle trajectories and ischemic heart diseases: a prospective cohort study in UK Biobank, European Journal of Preventive Cardiology, 2023;, zwad001, https://doi.org/10.1093/eurjpc/zwad001