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GMDS 2012: 57. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

16. - 20.09.2012, Braunschweig

The combined effects of healthy behaviors on cardiovascular diseases: a systematic review and meta-analysis

Meeting Abstract

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  • Martin Loef - Europa Universität Viadrina, Frankfurt/Oder, Deutschland

GMDS 2012. 57. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Braunschweig, 16.-20.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12gmds198

doi: 10.3205/12gmds198, urn:nbn:de:0183-12gmds1982

Published: September 13, 2012

© 2012 Loef.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Cardiovascular diseases (CVD) are the leading causes of death in the world and decisively influenced by lifestyle factors. Although much is known about the impact of single factors, the current evidence about the combined effects of lifestyle behaviors on the mortality due to CVD has not yet been systematically reviewed and analyzed.

Methods: We searched Medline, Embase, Global Health, and Somed up to September 2011. We searched for publications on the combined effects of lifestyle factors on the mortality cardiovascular diseases. The mean effect sizes that certain numbers (n=1, 2, 3, ≥ 4) of combined, dichotomous lifestyle factors (obesity, alcohol consumption, smoking, diet, and physical activity) have on mortality or morbidity were compared to the group with the least number of healthy lifestyle factors. We applied random effect meta-analysis to pool the single studies. Sensitivity analyses were conducted to explore the robustness of the results.

Results: Out of 4,506 articles identified by the literature search, nine studies met the inclusion criteria and comprised 235,446 people with a mean follow-up of 16.3 years. The hazard ratios decreased proportionate to a higher number of healthy lifestyle factors for the mortality due to cardiovascular diseases. Compared to an unhealthy behavior in each of the lifestyle factors, adherence to one healthy behavior resulted in a HR1=0.72 (95% confidence interval 0.62–0.83). Correspondingly, groups with two, three or at least four healthy behaviors had continuously decreasing risks of CVD mortality (HR2=0.58 (0.45–0.76), HR3=0.45 (0.33–0.61), HR4=0.31 (0.24–0.41)). Therefore, a combination of at least four healthy lifestyle factors reduced the CVD mortality risk by 69% (59%–76%).

Conclusion: A healthy lifestyle (comprising non-smoking, a healthy diet, regular physical activity, moderate alcohol consumption, and a normal body weight) is the best preventative measure against mortality from today’s most important non-communicable disease.