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Trajectories of healthy lifestyles score and cardiovascular disease: a cohort study
Shijie Shen1,2, Lanqing Ma1,2, Xiaoxue Li1,2
1Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Insights
Tracking healthy lifestyle score (HLS) trajectories reveals significant differences in cardiovascular disease (CVD) risk. Sustained low or unstable healthy lifestyles are linked to higher CVD incidence, emphasizing the importance of maintaining healthy habits.
Area of Science:
- Epidemiology
- Public Health
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) is a leading global cause of death.
- Healthy lifestyles are critical for cardiovascular health.
- Assessing lifestyle changes over time is crucial for understanding CVD risk dynamics.
Purpose of the Study:
- To identify distinct healthy lifestyle score (HLS) trajectories using a group-based trajectory model.
- To analyze the association between these HLS trajectories and the risk of developing CVD.
- To provide insights into dynamic lifestyle patterns and their impact on cardiovascular health.
Main Methods:
- A cohort study involving 2313 participants in rural southern Xinjiang, China.
- Annual follow-up surveys from 2016 to 2024, including lifestyle questionnaires and health measurements.
- Group-based trajectory modeling (SAS V.9.4 PROC TRAJ) and data visualization (R V.4.2.2).
Main Results:
- Five distinct HLS trajectories were identified: long-term low, mid-level stable increase, mid-level unstable increase, high-level decrease, and ideal trajectory.
- The long-term low HLS group showed the highest CVD risk (HR 6.23), followed by mid-level unstable increase (HR 4.14) and mid-level stable increase (HR 3.14) groups, compared to the ideal trajectory.
- Significant differences in HLS were observed across years (p<0.001).
Conclusions:
- Distinct healthy lifestyle score trajectories are associated with varying cardiovascular disease risks.
- Sustained low and unstable healthy lifestyles significantly increase CVD risk.
- Early adoption and consistent maintenance of healthy lifestyles are vital for long-term CVD risk reduction.
Objective:
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide, and healthy lifestyles play a crucial role in maintaining individual cardiovascular health. Given that both CVD progression and lifestyles are dynamic in nature, assessing the association between healthy lifestyles score (HLS) and CVD risk at a single time point may have certain limitations. This study aims to identify HLS trajectories via group-based trajectory model and analyse the relationship between these trajectories and CVD risk.
Design:
This cohort study completed the baseline survey in 2016 and conducted at least one follow-up annually from 2019 to 2024, with the first occurrence of CVD as the outcome. The epidemiological investigation included questionnaire surveys, anthropometric and physiological measurements and serum biochemistry tests. The group-based trajectory model was constructed via SAS V.9.4 PROC TRAJ and the results were visualised via R (V.4.2.2).
Setting:
This study involved a rural cohort in southern Xinjiang, China.
Participant:
A total of 2313 participants from four communities were included in this study, with a median (IQR) follow-up time of 6.86 (5.75-8.44) years.
Results:
The differences in HLS across years were significant (p<0.001), whereas the differences between the CVD group and the healthy control group were significant only in 2016 (p<0.001), 2019 (p<0.001) and 2024 (p<0.001). This study identifies five distinct HLS trajectory groups (long-term low, mid-level stable increase, mid-level unstable increase, high-level decrease and ideal trajectory). Compared with the ideal trajectory group, the long-term low-level group presented the highest risk of CVD incidence (HR 6.23, 95% CI 3.38 to 11.49), followed by the mid-level unstable increase group (HR 4.14, 95% CI 2.30 to 7.45) and the mid-level stable increase group (HR 3.14, 95% CI 1.73 to 5.70). The results of stratified analysis by gender, age, hyperlipidaemia, diabetes mellitus and hypertension are consistent with the main findings.
Conclusions:
Distinct trajectories of HLS corresponded to differing CVD risks. Moreover, both sustained low and unstable healthy lifestyles significantly contribute to CVD risk. Therefore, the early adoption and maintenance of healthier lifestyles provide long-term benefits in reducing CVD risk.
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