LAUSR

AIMS To evaluate the associations of baseline and long-term trajectories of lifestyle with incident ischemic heart diseases (IHD). METHODS 29,164 participants in the UK Biobank who had at least one follow-up assessment and were free of IHD at the last follow-up assessment were included. We constructed a weighted unhealthy lifestyle score though summing five lifestyle factors (smoking, physical activity, diet, BMI, and sleep duration). Lifestyle assessed at baseline (2006-2009), the first follow-up assessment (2012-2013) and the second follow-up assessment (since 2014) were used to derive the trajectories of each individual. The joint categories were created through cross-classifying three baseline lifestyle categories (ideal, intermediate and poor) by three lifestyle trajectory categories (improve, maintain and decline). RESULTS During a median follow-up period of 4.2 years, 868 IHD events were recorded. The hazard ratio (HR) of incident IHD associated with per unit increase in unhealthy lifestyle trajectory was 1.08 (95% confidence interval (CI): 0.99-1.17). Subgroup analyses indicated such association was stronger among individuals with hypertension (HR: 1.13, 95%CI: 1.03-1.24), diabetes (HR: 1.23, 95%CI: 0.96-1.58) or hyperlipidemia (HR: 1.09, 95%CI: 0.97-1.22). Compared with participants consistently adhering to an ideal lifestyle (ideal-maintain), the HRs of incident IHD were: 1.30 (1.07-1.58) for intermediate-maintain, 1.52 (1.23-1.88) for poor-maintain, 1.25 (0.93-1.68) for intermedia-improve, 1.48 (1.17-1.88) for poor-improve, 1.46 (1.08-1.99) for intermedia-decline and 1.77 (1.21-2.59) for poor-decline. CONCLUSIONS A declined lifestyle trajectory increased the risk of incident IHD, irrespective of baseline lifestyle levels. Individuals with hypertension, diabetes or hyperlipidemia were more predisposed to the influence of lifestyle change.