(P12-35-26) Lifestyle Factors and Incidence of Premature Major Adverse Cardiovascular Events in the VA Million Veteran Program

Objectives: Cardiovascular disease (CVD) is the leading cause of mortality in the US and is preventable with lifestyle modifications. However, it is unclear which modifiable lifestyle factors impact the onset of premature major adverse cardiovascular events (MACE) among Veterans.

Methods: Cohort study with 71,968 participants, including 45,820 males aged 21-54 years and 26,148 females aged 19-64 years. All were free of CVD with complete data on 8 low-risk lifestyle factors at baseline within the Million Veteran Program. Low-risk lifestyle factors included a higher-quality diet, being physically active, not smoking, restful sleep, no heavy alcohol intake, good stress management, social connections and support, and no opioid use disorder. Premature major adverse cardiovascular events (MACE) were defined as non-fatal stroke, myocardial infarction (MI), or CVD death prior to age 55 (males) or 65 (females).

Results: With 358,835 person years of follow up, there were 1,161 premature MACE cases, including 481 MI, 467 stroke and 238 CVD death. All 8 low-risk lifestyle factors were significantly associated with a lower risk of premature MACE. After adjustment for confounding factors, a higher low-risk lifestyle score was significantly associated with a reduced risk of premature MACE [hazard ratio (HR) comparing extreme groups (7-8 versus. 0-2) = 0.32, 95% confidence interval (CI): 0.23-0.45, P _trend < 0.0001]. Results were similar for MI [0.39 (95%CI: 0.23-0.65), P _trend=0.01], stroke [0.33 (95%CI: 0.20-0.54), P _trend=0.01] and CVD death [0.19 (95%CI: 0.07-0.46), P _trend < 0.0001]. Consistent associations were observed among males and females, those aged ≤45 years and >45 years, across different races and family income groups, and for obese and nonobese veterans (all Ps for interaction > 0.1).

Conclusions: Adherence to a low-risk lifestyle is associated with a low risk of premature MACE incidence in a dose-response manner among US Veterans.

Funding Sources: Department of Veterans Affairs