Is the association between healthy lifestyle behaviors and cardiovascular mortality modified by overweight status? The Japan collaborative cohort study

Objective: To examine the modifying effects of overweight status on the association of healthy lifestyle behaviors with cardiovascular mortality in the Japanese population. Methods: A community-based, prospective cohort of 18,730 men and 24,216 women aged 40-79. years without a history of cardiovascular disease (CVD) or cancer at baseline (1988-1990) was followed until 2009. Healthy lifestyle behaviors included intake of fruits, fish, and milk; exercise; avoidance of smoking; moderate alcohol intake; and moderate sleep duration. Results: During the median of 19.3. years of follow-up, there were 2412 deaths from total CVD. Inverse associations between healthy lifestyle scores and mortality from stroke, total CVD, and coronary heart disease (CHD) were observed for non-overweight and overweight (body mass index ≥. 25. kg/m2) individuals, although the association was weaker for overweight individuals. The multivariable hazard ratios (HRs, 95% confidence interval) of mortality from total CVD for the highest (6-7) versus the lowest (0-2) scores were 0.44 (0.37-0.54) for non-overweight and 0.56 (0.39-0.81) for overweight individuals. Especially for CHD mortality, such association was more evident for non-overweight compared to that for overweight individuals. Conclusions: Our findings suggest that lifestyle modification may be beneficial in the prevention of cardiovascular mortality for persons who are and are not overweight.