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Healthy Lifestyle’s Effect on Mortality Risk

Five lifestyle factors had individual and combined effects on risk for all-cause, CV, and cancer mortality.

The health effects of cigarette smoking, BMI, physical activity, diet, and alcohol intake as individual factors have been studied extensively, but less is known about their combined influence on long-term mortality. Now, Nurses’ Health Study investigators have evaluated the effects of combinations of these lifestyle factors on all-cause, cardiovascular (CV), and cancer mortality in 77,782 predominantly white, middle-aged women. Participants completed surveys biennially, and information about mortality was obtained during 24 years of follow-up.

One quarter of cancer deaths and one third of CV deaths were attributable to smoking. Obese women (BMI, >30 kg/m²) were almost three times as likely to die of CV causes than were women whose BMIs were lower (18.5–24.9); women who exercised 5.5 hours per week were approximately half as likely to die of CV disease as were women who were less active. Overall, 72% of CV mortality, 44% of cancer mortality, and 55% of all-cause mortality were attributable to having any of four risk factors: being overweight, smoking cigarettes, not engaging in physical activity, and having a low healthy-diet score. Having all four risk factors raised CV mortality risk sevenfold, more than doubled cancer mortality risk, and more than tripled all-cause mortality risk. Compared with alcohol abstinence, light-to-moderate alcohol consumption (up to 1 drink daily) was associated with lower CV mortality risk and, in general, was associated with lower risk for all-cause mortality.

Comment: These data clearly show that, although cigarette smoking has the greatest detrimental effect, unhealthy lifestyle factors have additive harmful influences on CV and cancer mortality. The authors emphasize that light-to-moderate alcohol consumption should not be encouraged as a means to lower long-term mortality risk. Instead, clinicians generally should advise patients to limit alcohol to one drink daily and should continue to counsel patients about other factors that they can control: quitting smoking, increasing physical activity, following a healthy diet, and maintaining an appropriate weight.

— Wendy S. Biggs, MD

Published in Journal Watch Women's Health September 16, 2008

Citation(s):

van Dam RM et al. Combined impact of lifestyle factors on mortality: Prospective cohort study in US women. BMJ 2008 Sep 17; 337:a1440. (http://dx.doi.org/10.1136/bmj.a1440)

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