Healthy Lifestyle Score and the Risk of Cardiovascular Disease, Cancer, and Mortality in an Asian Population: Prospective Cohort Study

Abstract Background Healthy lifestyle behaviors are key modifiable factors for the prevention of chronic diseases and premature mortality. Composite lifestyle scores provide a practical framework for capturing the combined impact of multiple health behaviors, but prospective evidence from multiethnic Asian populations remains limited. Objective This study examined the associations between a composite healthy lifestyle score and the risk of cardiovascular diseases, cancer, and all-cause mortality in a multiethnic Asian population. Methods We analyzed prospective data from 9920 participants of the Singapore Multi-Ethnic Cohort who were free of major chronic diseases at baseline. A healthy lifestyle score was constructed from 5 components: BMI, smoking, physical activity, diet quality, and screen time. Scores ranged from 0 to 10, with higher scores reflecting healthier lifestyles. An expanded score, including mental well-being, was examined in a subset. Hazard ratios (HRs) and 95% CIs were estimated using the Cox proportional hazards model for acute myocardial infarction (AMI), stroke, cancer, and all-cause mortality, adjusting for sociodemographic factors, energy intake, family history of cancer or heart disease, and menopause status. Results During a median follow-up of 14 years, 457 AMI cases, 322 stroke cases, 707 cancer incident cases, and 631 deaths were identified. More favorable lifestyle scores were associated with lower risk of cardiovascular outcomes and mortality, consistent with a dose-response relationship. Compared to participants scoring 8 to 10, those with the lowest score (0-3) had more than 2 times the risk of AMI (HR 2.13, 95% CI 1.47-3.07), stroke (HR 3.21, 95% CI 2.12-4.85), and all-cause mortality (HR 2.01, 95% CI 1.46-2.78). In contrast, no significant associations were observed for cancer incidence. Incorporating mental well-being into the lifestyle score yielded similar results. Conclusions Adherence to a healthy lifestyle was associated with a lower risk of AMI, stroke, and mortality in a multiethnic Asian cohort, highlighting the importance of integrated lifestyle approaches for chronic disease prevention.