Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults

To estimate the prevalence of healthy lifestyle characteristics and to examine the association between different combinations of healthy lifestyle characteristics and cardiovascular disease biomarkers.

The prevalence of healthy lifestyle characteristics was estimated for the US adult population (N=4745) using 2003-2006 National Health and Nutrition Examination Survey data for the following parameters: being sufficiently active (accelerometer), eating a healthy diet (Healthy Eating Index based on 24-hour recalls), being a nonsmoker (serum cotinine level), and having a recommended body fat percentage (dual-energy X-ray absorptiometry). Cardiovascular biomarkers included mean arterial pressure, C-reactive protein, white blood cells (WBCs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, fasting low-density lipoprotein cholesterol, fasting triglycerides, fasting glucose, fasting insulin, insulin resistance, hemoglobin A1c, and homocysteine. The study was conducted from August 15, 2013, through January 5, 2016.

Only 2.7% (95% CI, 1.9%-3.4%) of all adults had all 4 healthy lifestyle characteristics. Participants with 3 or 4 compared with 0 healthy lifestyle characteristics had more favorable biomarker levels except for mean arterial blood pressure, fasting glucose, and hemoglobin A1c. Having at least 1 or 2 compared with 0 healthy lifestyle characteristics was favorably associated with C-reactive protein, WBCs, HDL-C, total cholesterol, and homocysteine. For HDL-C and total cholesterol, the strongest correlate was body fat percentage. For homocysteine, a healthy diet and not smoking were strong correlates; for WBCs, diet was not a strong correlate.

Although multiple healthy lifestyle characteristics are important, specific health characteristics may be more important for particular cardiovascular disease risk factors.