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J Prev Med Public Health. 2013 Nov;46(6):319-328. English. Original Article.
Kim JY , Ko YJ , Rhee CW , Park BJ , Kim DH , Bae JM , Shin MH , Lee MS , Li ZM , Ahn YO .
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
Department of Social Medicine, Hallym University College of Medicine, Chuncheon, Korea.
Department of Preventive Medicine, Cheju National University College of Medicine, Jeju, Korea.
Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea.
Department of Epidemiology and Statistics, School of Public Health Sciences, Jilin University, Changchun, China.
Korean Foundation for Cancer Research, Seoul, Korea.

OBJECTIVES: This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. METHODS: In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. RESULTS: There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. CONCLUSIONS: Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.

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