What is the Effect of Lifestyle Factors on CVD Risk Prediction in Women?
Examining the association of multiple healthy lifestyle factors such as physical activity, diet, and adiposity on reducing cardiovascular disease risk, new evidence has found that while such daily components have an important effect on cardiovascular disease potential, their addition to established models does not result in clear improvement in overall prediction, according to a study published Aug. 25 in Circulation.
The study was led by Nina Paynter, PhD, MHS, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, and looked at a case-cohort of post-menopausal non-smokers in the multiethnic Women’s Health Initiative Observational Study (1,587 cases and 1,808 sub-cohort participants) with a median follow-up of 10 years in non-cases.
The analysis found that in comparison to non-smokers with no other healthy lifestyle factors – healthy diet, recreational physical activity, low adiposity, and moderate alcohol use – the risk of cardiovascular disease was lower for each additional factor (hazard ratio for trend 0.82; 95 percent CI 0.76, 0.89), demonstrating a 45 percent reduction in risk among all factors (95 percent CI 0.36, 0.84). However, when lifestyle factors were added to traditional risk factor models, variables culled from the Pooled Cohort and Reynolds risk scores – only recreational physical activity remained independently associated with the risk of cardiovascular disease. The addition of detailed lifestyle measures to traditional models also showed a change in the Discrimination Improvement and continuous Net Reclassification Index (p < 0.01 for both), but in the end had little impact on more clinically relevant risk stratification measures.
The authors note that “improvements in lifestyle factors, especially physical activity and adiposity have been shown to reduce traditional cardiovascular risk factors, and are thus intrinsically important to reducing overall cardiovascular risk over the long term.” They add that their study showed that lifestyle factors “do not appear to improve prediction over the traditional models,” and note that moving forward, “whether a risk prediction score that includes lifestyle information would be useful to patients or physicians in motivation behavior change will require further research.”
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