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Daily Dose: Healthy Lifestyle & Risk of CVD Among Postmenopausal Women With Normal BMI


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On June 21, 2023, we reported on a study published in the Journal of the American Heart Association that examined the association of a healthy lifestyle index (HLI) with the risk of incident cardiovascular disease (CVD) and CVD subtypes in postmenopausal women with normal body mass index (BMI) (18.5–<25.0 kg/m2).

The study

Researchers created a HLI based on 5 lifestyle-related factors: waist circumference, cigarette smoking, alcohol intake, diet quality, and leisure‐time physical activity. A score (0–4) was assigned to individual categories of each lifestyle component, with higher scores reflecting healthier behaviors. The scores for each factor were summed to generate a composite HLI score (0–20), again with higher scores indicating healthy regimens.

Participant data was drawn from the WHI with the final cohort for analysis comprised of 40 118 women aged 40-59 years with BMI between 18.5 and 25.0 kg/m2 and without history of CVD. Participants were subsequently stratified by quintiles of calculated HLI scores.

The primary outcome was the first occurrence of CVD which included stroke, CHD, angina requiring hospitalization, and coronary revascularization procedures, as defined in the WHI.

The findings

Researchers reported that during a median follow-up of 20.1 years, there were 3821 documented cases of a first CVD event. They found that women in the higher quintiles of HLI scores compared to those in lowest quintiles were at lower risk for incident CVD overall with hazard ratios (HR) as follows: quintile 2, HR 0.74; 95% CI, 0.67-0.81; quintile 3, HR 0.66; 95% CI, 0.6-0.72; quintile 4, HR 0.57; 95% CI, 0.51-0.63; quintile 5, HR 0.48; 95% CI, 0.43-0.54 (P for trend <.001).

They also reported an inverse association between HLI and risks of CVD components -- stroke, CHD, MI, angina, and coronary revascularization. Further, the inverse association between HLI score and risk of CVD remained significant across subgroup analyses, stratified by age (≤63 years vs >63 years), BMI (/≥ 22.0 kg/m2), and general health status, eg, absence/presence of hypertension, diabetes, or lipid‐lowering drug use.

A note from authors

"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, MI, angina, and coronary revascularization."

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