Journal of the American College of Cardiology
Original Investigation
Adherence to Healthy Lifestyle and Cardiovascular Diseases in the Chinese Population
Jun Lv, Canqing Yu, Yu Guo, Zheng Bian, Ling Yang, Yiping Chen, Xuefeng Tang, Weiyuan Zhang, Yijian Qian, Yuelong Huang, Xiaoping Wang, Junshi Chen, Zhengming Chen, Lu Qi, Liming Li, China Kadoorie Biobank Collaborative Group, Junshi Chen, Zhengming Chen, Rory Collins, Liming Li, Richard Peto, Daniel Avery, Ruth Boxall, Derrick Bennett, Yumei Chang, Yiping Chen, Zhengming Chen, Robert Clarke, Huaidong Du, Simon Gilbert, Alex Hacker, Michael Holmes, Andri Iona, Christiana Kartsonaki, Rene Kerosi, Ling Kong, Om Kurmi, Garry Lancaster, Sarah Lewington, Kuang Lin, John McDonnell, Winnie Mei, Iona Millwood, Qunhua Nie, Jayakrishnan Radhakrishnan, Sajjad Rafiq, Paul Ryder, Sam Sansome, Dan Schmidt, Paul Sherliker, Rajani Sohoni, Iain Turnbull, Robin Walters, Jenny Wang, Lin Wang, Ling Yang, Xiaoming Yang, Zheng Bian, Ge Chen, Yu Guo, Bingyang Han, Can Hou, Jun Lv, Pei Pei, Shuzhen Qu, Yunlong Tan, Caning Yu, Haiyan Zhou, Zeng hang Pang, Ruin Gao, Shoji Wang, Yong-Mei Liu, Ran ran Du, Yajing Zang, Liang Cheng, Xiaocao Tian, Hua Zhang, Silu Lv, Junzheng Wang, Wei Hou, Jiyuan Yin, Ge Jiang, Xue Zhou, Liqiu Yang, Hui He, Bo Yu, Yanjie Li, Huaiyi Mu, Qinai Xu, Meiling Dou, Jiaojiao Ren, Shanqing Wang, Ximin Hu, Hongmei Wang, Jinyan Chen, Yan Fu, Zhenwang Fu, Xiaohuan Wang, Min Weng, Xiangyang Zheng, Yilei Li, Huimei Li, Yanjun Wang, Ming Wu, Jinyi Zhou, Ran Tao, Jie Yang, Chuanming Ni, Jun Zhang, Yihe Hu, Yan Lu, Liangcai Ma, Aiyu Tang, Shuo Zhang, Jianrong Jin, Jingchao Liu, Zhenzhu Tang, Naying Chen, Ying Huang, Mingqiang Li, Jinhuai Meng, Rong Pan, Qilian Jiang, Weiyuan Zhang, Yun Liu, Liuping Wei, Liyuan Zhou, Ningyu Chen, Hairong Guan, Xianping Wu, Ningmei Zhang, Xiaofang Chen, Xuefeng Tang, Guojin Luo, Jianguo Li, Xiaofang Chen, Xunfu Zhong, Jiaqiu Liu, Qiang Sun, Pengfei Ge, Xiaolan Ren, Caixia Dong, Hui Zhang, Enke Mao, Xiaoping Wang, Tao Wang, Xi zhang, Ding Zhang, Gang Zhou, Shixian Feng, Liang Chang, Lei Fan, Yulian Gao, Tianyou He, Huarong Sun, Pan He, Chen Hu, Qiannan Lv, Xukui Zhang, Min Yu, Ruying Hu, Hao Wang, Yijian Qian, Chunmei Wang, Kaixue Xie, Lingli Chen, Yidan Zhang, Dongxia Pan, Yuelong Huang, Biyun Chen, Li Yin, Donghui Jin, Huilin Liu, Zhongxi Fu, Qiaohua Xu, Xin Xu, Hao Zhang, Youping Xiong, Huajun Long, Xianzhi Li, Libo Zhang and Zhe Qiu
Table 2
Table 2
Multivariable-Adjusted HRs (95% CIs) for Incident Ischemic Stroke by Lifestyle Factors Among 461,211 Participants
| (ncase = 19,348) | Cases | Cases/PYs (/1,000) | HR (95% CI) | ptrend∗ |
|---|---|---|---|---|
| Smoking | ||||
| Never | 12,141 | 5.46 | 1.00 | — |
| Former | 839 | 9.28 | 0.98 (0.91–1.06) | — |
| Current (cigarettes/day) | ||||
| <15 | 2,756 | 7.95 | 1.17 (1.11–1.23) | 0.018 |
| 15-24 | 2,655 | 6.09 | 1.22 (1.16–1.29) | |
| ≥25 | 957 | 5.62 | 1.22 (1.13–1.31) | |
| Alcohol consumption | ||||
| Never | 15,230 | 5.73 | 1.00 | — |
| Former | 1,111 | 9.70 | 1.24 (1.16–1.32) | — |
| Current weekly | 1,079 | 5.47 | 0.90 (0.84–0.96) | — |
| Current daily (g/day) | ||||
| <15 | 170 | 10.96 | 0.94 (0.81–1.10) | 0.029 |
| 15-29 | 422 | 7.40 | 0.90 (0.81–0.99) | |
| 30-59 | 680 | 6.97 | 1.00 (0.92–1.09) | |
| ≥60 | 656 | 5.06 | 1.06 (0.97–1.15) | |
| Physical activity (MET-h/day) | ||||
| <11.0 | 8,713 | 11.18 | 1.00 | <0.001 |
| Men 11.0-19.9, Women 11.0-17.9 | 5,482 | 6.49 | 0.92 (0.89–0.96) | |
| Men 20.0-33.4, Women 18.0-29.4 | 2,994 | 3.65 | 0.89 (0.85–0.93) | |
| Men ≥33.5, Women ≥29.5 | 2,159 | 2.63 | 0.84 (0.79–0.88) | |
| Dietary pattern | ||||
| Daily FV, weekly but not daily meat | 1,397 | 6.56 | 1.00 | — |
| Less than daily FV, daily meat | 133 | 8.87 | 1.35 (1.12–1.61) | — |
| Intermediate pattern | 17,818 | 5.86 | 1.13 (1.07–1.20) | — |
| BMI (kg/m2) | ||||
| <18.5 | 786 | 5.52 | 0.94 (0.88–1.02) | <0.001 |
| 18.5-23.9 | 8,756 | 5.00 | 1.00 | |
| 24.0-27.9 | 7,136 | 6.75 | 1.09 (1.05–1.13) | |
| ≥28.0 | 2,670 | 8.42 | 1.14 (1.09–1.20) | |
| WHR | ||||
| Men <0.90, women <0.85 | 6,712 | 4.68 | 1.00 | <0.001 |
| Men 0.90-0.94, women 0.85-0.89 | 5,690 | 6.19 | 1.12 (1.08–1.16) | |
| Men ≥0.95, women ≥0.90 | 6,946 | 7.60 | 1.15 (1.11–1.20) | |
Values are cases, cases/PYs, HR, and 95% CI. Multivariable model was adjusted for age, sex, education, marital status, family history of stroke, and prevalent hypertension at baseline. All 6 lifestyle factors were included simultaneously in the same model.
Abbreviations as in Table 1.
↵∗ The linear trend test for smoking was performed only in current smokers, and the linear trend test for alcohol consumption was performed only in current daily drinkers.
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