The Effect of Health-Conscious Lifestyle Maintenance on CVD Risk Post-Menopause

Maintenance of a healthy lifestyle in postmenopausal patients significantly reduces risk for first cardiovascular disease (CVD) event over a 20-year period, according to a new study published in the Journal of the American Heart Association.

A high healthy lifestyle index, which consists of a high-quality diet, low alcohol consumption, and no cigarette smoking, is associated with a reduced risk for CVD. However, there is little evidence that the culmination of these behavioral factors may play a synergistic role in reducing risk for CVD amongst individuals with a normal BMI. Researchers aimed to investigate the effects of grouped healthy lifestyle indices and their risk reduction of CVD among postmenopausal women.

An observational study was conducted utilizing 40,118 participants from the Women’s Health Initiative, aged 40 to 59 years with a BMI between 18.5 and 24.9. Participants were stratified into quintiles based off of a novel healthy lifestyle index (HLI) score. The HLI score was based on 5 lifestyle factors: waist circumference, cigarette smoking, alcohol intake, diet quality, and physical activity. Individual categories were scored from 0 to 4, with a composite HLI score indicating healthier regimens. Participants were subsequently stratified into quintiles, according to calculated HLI score.

The primary outcome was the first occurrence of a CVD event, which consisted of stroke, congestive heart disease, angina requiring hospitalization and coronary revascularization procedures. Over a median follow-up time of 20.1 years, a total of 3821 cases of a first CVD event occurred. An inverse relationship was found, noting a higher composite HLI score linked to lower risk of incident CVD. Hazard ratios (HRs) for all-incident CVD were as follows:

• Quintile 2: HR, 0.74; 95% CI, 0.67 to 0.81
• Quintile 3: HR, 0.66; 95% CI, 0.60 to 0.72
• Quintile 4: HR, 0.57; 95% CI, 0.51-0.63
• Quintile 5: HR, 0.48; 95% CI, 0.43-0.54 (P  trend <.001).

Similarly, subgroup analysis which stratified individuals by age, BMI, and general health status found a higher healthy lifestyle index significantly reduced risk for first CVD event in all groups.

Furthermore, inverse dose-response associations were found for all individual HLI components, except for alcohol intake. However, no statistically significant difference was noted in CVD categories between patients that drink alcohol and those that do not.

Lack of information on changed lifestyle factors during follow-up is cited as a potential limitation that may have altered the observed findings.

The study authors wrote, “The results of this study suggest that in postmenopausal women with normal BMI, a healthy lifestyle including a high-quality diet, moderate or intense physical activity, no current smoking, moderate alcohol intake, and a small waist circumference, is inversely associated with the risk of CVD and its subtypes, including stroke, CHD [coronary heart disease], MI [myocardial infarction], angina, and coronary revascularization.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.