Changes in health behaviors and cardiovascular disease: a register-linkage study in Finland

Abstract Background This study investigates the association between changes in health behaviors (HBs, including smoking, physical inactivity, alcohol consumption, unhealthy diet, and sleep problems) and cardiovascular disease (CVD) risk among midlife and older individuals stratified by metabolic risk factors (hypertension, hypercholesterolemia, obesity, and diabetes). Methods Using survey data linked with national health registries, we followed 4,470 individuals (74% women; median age 56.1 years) over an average follow-up of 11 years (2007-2022). Predicted survival curves were used to estimate how changes in HBs contributed to median survival times for CVD incidence across metabolic risk groups. Cox regression models were used to calculate hazard ratios (HRs). Results During the follow-up, 1,879 participants (42%) developed CVD. Among individuals without metabolic risk factors, improvement in the HB score was associated with a lower CVD risk and an 8.1-year gain in median survival (HR = 0.59, 95% CI: 0.41-0.86). Across all metabolic risk groups, increased physical activity showed the strongest association with reduced CVD risk, particularly among individuals with hypertension (HR = 0.66, 95% CI: 0.49-0.87), diabetes (HR = 0.51, 95% CI: 0.30-0.87), and obesity (HR = 0.63, 95% CI: 0.43-0.93). Conclusions Our findings show that changes in health behaviors were associated with a reduced risk of CVD, with varying benefits across metabolic risk profiles. Interventions that promote healthy behaviors are warranted, with interventions promoting physical activity potentially offering the greatest benefit for individuals with existing metabolic risk factors. Key messages • Positive health behavior changes, particularly increased physical activity, significantly reduce cardiovascular disease risk, with effects varying by metabolic risk profile. • Physical activity-focused interventions could lower CVD risk for individuals with hypertension, hypercholesterolemia, diabetes, or obesity.