Healthy Lifestyle Score and Cardiovascular Diseases: Findings from Three European Health Surveys

Abstract Background Cardiovascular diseases (CVDs) remain a leading public health challenge in Europe. Modifiable lifestyle factors are critical determinants of CVD risk. This study aimed to assess the association between a composite healthy lifestyle score and CVD prevalence using data from three waves of the European Health Interview Survey (EHIS). Methods Data were obtained from EHIS Wave 1 (2006-2009; 16 countries), Wave 2 (2013-2015; 30 countries), and Wave 3 (2018-2020; 29 countries). A Healthy Lifestyle Score (range: 0-5) was calculated based on non-smoking, moderate alcohol consumption, healthy body mass index, regular physical activity, and daily consumption of fruits and vegetables. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the healthy lifestyle score and CVDs. Results A total of 801,972 respondents from three survey waves were included in the analysis. Higher healthy lifestyle scores were consistently and significantly associated with lower odds of CVDs across all three waves. The pooled ORs were 0.872 (95% CI: 0.857-0.888) in Wave 1, 0.792 (95% CI: 0.786-0.798) in Wave 2, and 0.640 (95% CI: 0.631-0.650) in Wave 3 (all p < 0.001). The mean healthy lifestyle scores were 2.75 ± 0.94, 2.46 ± 1.11, and 2.72 ± 1.04 in Waves 1, 2, and 3, respectively. The prevalence of CVDs increased over time, from 23.6% in Wave 1 to 25.2% in Wave 2, and 27.8% in Wave 3. At the country level, Slovakia (Wave 1), Ireland (Wave 2), and Austria (Wave 3) exhibited the strongest inverse associations between healthy lifestyle scores and CVD prevalence, with ORs of 0.723, 0.650, and 0.583, respectively. Conclusions A higher healthy lifestyle score was consistently associated with reduced odds of CVDs across all survey waves. However, rising CVD prevalence despite modest lifestyle improvements highlights the urgent need for reinforced public health strategies to promote healthier living across Europe. Key messages • Healthy lifestyle behaviors significantly reduce the odds of cardiovascular diseases across Europe, based on analysis of three large European Health Interview Survey waves. • Despite lifestyle improvements, cardiovascular diseases prevalence rose, highlighting the need for stronger public health action to promote and sustain healthy behaviors across European countries.