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Additive Effect of Adherence to Multiple Healthy Behaviors on Subclinical Atherosclerosis
Study Questions:
What is the relationship between adherence to multiple healthy lifestyle behaviors and subclinical atherosclerosis?
Methods:
This study used the Aragon Workers Health Study, a longitudinal cohort study that looked at subclinical atherosclerosis and metabolic abnormalities in a middle-aged population free of cardiovascular disease. It investigated the relationship between subclinical atherosclerosis and combinations of the following five healthy lifestyle behaviors:
- Moderate alcohol consumption
- Normal waist circumference
- Non-smoking
- Sitting time <5 hours
- Adherence to a Mediterranean diet
Subclinical atherosclerosis was defined as coronary artery calcium scoring >0 and/or the presence of at least one atherosclerotic plaque measured in the bilateral carotid or femoral arteries measured by two-dimensional ultrasound.
Results:
Adopting individual healthy lifestyle behaviors was associated with lower risk, and adherence to multiple healthy lifestyle behaviors was found to have synergistic effects on the presence of subclinical atherosclerosis. Complying with any three of the five healthy lifestyle behaviors was associated with a 16% lower prevalence of subclinical atherosclerosis. Specifically, moderate alcohol consumption, not smoking, and following a Mediterranean diet together were associated with an 18% lower prevalence of atherosclerotic plaques.
Conclusions:
Adopting individual healthy lifestyle behaviors reduces the risk of developing atherosclerotic plaques. Adopting multiple healthy lifestyle behaviors, specifically non-smoking, moderate alcohol intake, and following a Mediterranean diet, has an additive effect on the reduction of subclinical atherosclerosis.
Perspective:
This study has implications for clinicians, public health educators, and patients. Health education often focuses on one aspect of a healthy lifestyle: smoking cessation, adopting healthy eating habits, exercise, etc. This study demonstrates that adopting multiple healthy behaviors can have an additive impact on a patient’s health. As the authors point out, developing simple messaging that emphasizes an overall healthy lifestyle, particularly in younger populations, has the potential to reduce atherosclerotic disease burden in the population as a whole.
Keywords: Plaque, Atherosclerotic, Atherosclerosis, Health Behavior, Diet, Mediterranean, Feeding Behavior, Smoking Cessation, Smoking, Waist Circumference, Alcohol Drinking, Cardiovascular Diseases, Health Education, Health Educators
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