Healthy lifestyle behaviours and cardiovascular mortality among Japanese men and women: the Japan collaborative cohort study

Aims To examine the combined impacts of healthy lifestyle behaviours on cardiovascular disease (CVD) in Asians. Methods A total of 18 747 men and 24 263 women aged 40-79 without a history of stroke or coronary heart disease (CHD) and results at baseline in 1988-90 were followed up until 2006. Participants scored one point for each following lifestyle behaviour: consumption of fruits ≥1 intake per day, fish ≥1 intake per day, milk almost every day, exercise ≥5 h per week and/or walking ≥1 h per day, body mass index (BMI) of 21―25 kg/m2, alcohol intake <46.0 g per day, non-smoking, and sleep duration of 5.5-7.5 h per day. During 16.5 years of follow-up, there were 1907 deaths from total CVDs including 849 strokes and 402 CHDs. For both genders, persons with the highest scores had the lowest CVD mortality. The multivariable hazard ratios (95% confidence interval, population-attributable fraction) for the highest (7-8) vs. lowest (0-2) score categories were 0.35 (0.25-0.49, 52.3%) in men, and 0.24 (0.16-0.36, 44.6%) in women. Similar associations were found for stroke: 0.36 (0.22-0.58, 45.0%) in men and 0.28 (0.15―0.53, 43.4%) in women, and for CHD: 0.19 (0.08-0.50, 76.2%) and 0.20 (0.09-0.47, 34.5%), respectively. Conclusion Mortality from stroke, CHD, and CVD in the highest healthy lifestyle score category was one-third in men and one-fourth in women of those in the lowest scores, suggesting that a large fraction of CVD could be prevented through lifestyle modification.