Associations between healthy lifestyle practices and cardiovascular disease risk among Chinese adults: a nationwide cohort study

Abstract Background Cardiovascular disease (CVD) is the leading global cause of mortality and imposes substantial health and economic burdens. However, the overall relationship between combined lifestyle factors and CVD incidence among Chinese adults remains poorly defined. This study aimed to explore the association between healthy lifestyle factors and CVD risk in a nationwide Chinese cohort. Methods We included 7349 participants from 2011–2012 and followed them until 2018. Lifestyle was assessed using seven factors (blood pressure, blood glucose, cholesterol, body mass index (BMI), tobacco exposure, physical activity, and sleep duration), and participants were categorized into three groups based on the number of ideal factors. Cox regression models were used to analyze data. Results Participants with intermediate and unfavorable lifestyles had 29.74% and 59.71% higher CVD risks, respectively, compared to those with favorable lifestyles. Former smokers, individuals with elevated blood glucose, higher BMI, and inadequate sleep duration also had increased CVD risks. Subgroup and sensitivity analyses showed consistent trends. Conclusion This nationwide cohort study highlights that healthy lifestyle practices are significantly associated with reduced CVD risk. Promoting healthy behaviors through public health strategies is crucial to mitigating CVD risk. Key messages What is already known on this topic: Modifiable lifestyle factors are established drivers of CVD, but composite lifestyle scores lacked nationally representative evidence in China’s aging population before this study. What does this study add: Unhealthy lifestyles, including factors such as blood pressure, glucose levels, and BMI, significantly increased the risks of CVD and stroke in Chinese adults. Conditions like obesity, hyperglycemia, and poor sleep independently elevated these risks across all subgroups. How this study might affect research, practice, or policy: This study advocates multifactorial lifestyle interventions into public health policies, targeting high-risk populations, and prioritizing research on the scalability of these interventions.