1. Healthy lifestyle practices prevent premature death comparably between users and non-users of preventive medications
Evidence Rating: 2 (Good)
In the USA, cardiovascular disease (CVD) and cancer are the two leading causes of death. Preventive medications have been shown to lower the risk of CVD and some forms of cancer, but healthy lifestyle practices can also be preventive, and have been estimated to prevent more than 60% of premature deaths. This prospective cohort study examined how healthy lifestyle practices were associated with premature death in users and non-users of preventive medication. Two cohorts in the US were studied: The Nurses’ Health Study (over 120,000 female nurses) and Health Professionals Follow-up Study (over 50,000 male health professionals). The healthy lifestyle factors in question were BMI, cigarette smoking, alcohol consumption, diet, and physical exercise. The preventive medications examined were aspirin, antihypertensives, and lipid-lowering medications. Both the healthy lifestyle practices and preventive medications were evaluated on a binary scale for each participant. Premature deaths from CVD, cancer, and any cause were examined. The results found that each healthy lifestyle practice was significantly associated with lower all-cause mortality in both the medication users and non-users groups (all P interaction > 0.25). When all 5 factors were pooled into a healthy lifestyle score, the hazards-ratio (HR) for all-cause mortality was 0.82 (95% CI, 0.81-0.82) for users and 0.81 (95% CI, 0.79-0.83) for non-users (P interaction = 0.54). For cancer, the HR was 0.82 (95% CI, 0.81-0.83) in users and 0.82 (95% CI, 0.78-0.85) in non-users (P interaction = 0.94). And for CVD, the HR was 0.81 (95% CI, 0.79-0.82) in users and 0.74 (95% CI, 0.69-0.78) in non-users (P interaction = 0.01). Compared to cancer and all-cause mortalities, healthy lifestyle factors in CVD have the largest difference between the users and non-users group, suggesting that these healthy practices act on mechanisms distinct from the medications. Overall though, these findings show that regardless of medication use, healthy lifestyle practices are a significant factor in preventing premature death, which have implications for how lifestyle changes can be used in conjunction with pharmaceutical therapies to treat chronic disease.
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