The additive effect of adherence to multiple healthy lifestyles on subclinical atherosclerosis: Insights from the AWHS

Irina Uzhova, Rocio Mateo-Gallego, Belen Moreno-Franco, Esther Molina-Montes, Montserrat Leon-Latre, Jose A. Casasnovas Lenguas, Fernando Civeira, Jose L. Penalvo

Research output: Contribution to journalA1: Web of Science-article


BACKGROUND: Public health strategies targeting multiple healthy behaviors, rather than individual factors, have been proposed as more efficient strategies to promote cardiovascular health. However, the additive effect of multiple targets on primary prevention has not been fully characterized.

OBJECTIVE: To examine how adherence to multiple healthy behaviors is associated with the presence of subclinical atherosclerosis, a measure of early cardiovascular disease.

METHODS: Analysis of a baseline data from 1798 middle-aged men from the Aragon Workers Health Study conducted between 2009 and 2010. Healthy behaviors were defined according to American Heart Association recommendations, aligned with Spanish Nutritional recommendations and included moderate alcohol consumption, smoking abstinence, no abdominal adiposity, decreased sedentarism, and adherence to Alternate Mediterranean Dietary Index. Presence of coronary artery calcium and plaques in femoral and carotid was quantified by a 16-slice computed tomography scanner and 2D ultrasound.

RESULTS: Moderate alcohol consumption, as well as adherence to Mediterranean diet is independently associated with a 6% lower risk of having subclinical atherosclerosis. Smoking abstinence is associated with a 11% lower risk of subclinical atherosclerosis. Those who follow 3 lifestyle behaviors (Mediterranean diet, nonsmoking, and moderate alcohol intake) have 18% lower odds of presenting subclinical atherosclerosis compared with those who do not follow these protective lifestyle habits.

CONCLUSION: Adoption of multiple healthy lifestyle behaviors early in life could be a key strategy to tackle the onset of atherosclerosis and reduce cardiovascular disease burden. (C) 2018 National Lipid Association. All rights reserved.

Original languageEnglish
JournalJournal of Clinical Lipidology
Issue number3
Pages (from-to)615-625
Number of pages11
Publication statusPublished - 2018


  • Healthy lifestyle
  • Atherosclerosis
  • Coronary artery calcium
  • Atherosclerotic plaque
  • MEN

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