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Survival Associated with Healthy Lifestyle Even with Multiple Meds on Board


AHA 2020 Virtual Scientific Sessions: Healthy lifestyle habits are inversely associated with-all cause mortality, study authors found.

Healthy lifestyle habits are inversely associated with all-cause mortality regardless of medication burden, according to preliminary research to be presented at the virtual American Heart Association’s Scientific Sessions 2020, November 13 -17, 2020. Presentation P929

“We’ve long known about the benefits of leading a healthy lifestyle. The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications,” said lead author Neil Kelly, Ph.D., a medical student at Weill Cornell Medicine of Cornell University in New York City.

The Study

Researchers analyzed data from more than 20 000 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (mean age 64 years; 56% women). They evaluated the number of medications taken, level of participation in 4 healthy lifestyle behaviors and the rate of all-cause mortality.

At study start, participant use of prescription medications was:

  • 44% ≤4 no polypharmacy
  • 39% 5 to 9 polypharmacy
  • 17% ≥10 hyperpolypharmacy

Medication types varied widely for conditions that included heart disease, diabetes, kidney disease, cognitive impairment.

Healthy lifestyle variables (4) were scored from 0 (low adherence) to 2 (high adherence):

  • Adherence to a Mediterranean diet
  • Physical activity
  • Smoking abstinence
  • Avoidance of sedentary lifestyle (ie, low TV time)

Authors also examined a cumulative Health Behavior Score (HBS) based on the sum of individual behavior scores (range 0-8).

The association between each behavior and mortality was evaluated using estimated Cox proportional hazards models for each baseline medication burden stratum (level of polypharmacy) adjusting for sociodemographics, health status, comorbid conditions, and medication adherence.


Mortality increased with increasing medication burden:

  • No polypharmacy 19.1%
  • Polypharmacy 29.7%
  • Hyperpolypharmacy 41.3%

The highest score for each behavior was inversely associated with all-cause mortality in all 3 strata. The highest HBS for each stratum conferred substantial benefit:

  • No polypharmacy HR 0.52 (95% CI 0.45-0.61)
  • Polypharmacy HR 0.755 (95% CI 0.49-0.63)
  • Hyperpolypharmacy HR 0.69 (95% CI 0.58-0.82)


Healthy lifestyle was inversely associated with all-cause mortality irrespective of medication burden, supporting the value of healthy lifestyle counseling even among adults with high medication burden.

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