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Healthy lifestyle lowers mortality irrespective of medication burden

Presented by
Dr Neil Kelly, Weill Cornell University, USA
AHA 2020
A healthy lifestyle, including a healthy diet, regular exercise, and not smoking, is inversely associated with all-cause mortality regardless of polypharmacy [1]. These outcomes support the value of healthy lifestyle counselling, even among adults with a high medication burden.

Dr Neil Kelly (Weill Cornell University, USA) and colleagues analysed data from 20,417 participants of the REGARDS study. The mean age was 64.8 years, and 56% were women. The researchers evaluated the level of exposure to 4 healthy behaviours, degree of polypharmacy, and all-cause death rates. Adherence to 4 healthy behaviours was scored: a Mediterranean diet, physical activity, smoking abstinence, and sedentary lifestyle avoidance (low TV time). A Mediterranean diet emphasises fruits, legumes and vegetables, whole grains, fish oil, and olive oil, as well as moderation for dairy products and wine. Each behaviour was scored from 0 (low adherence) to 2 (high adherence). A cumulative Health Behavior Score (HBS) was based on the sum of individual behaviour scores (range 0–8). At baseline, 44% of participants used <5 medications (i.e. no polypharmacy), 39% used 5–9 medications (i.e. polypharmacy), and 17% used ≥10 medications (i.e. hyperpolypharmacy).

After a mean follow-up of 9.8 years, the primary endpoint of mortality increased with higher medication burden:

      • no polypharmacy: 19.1%;
      • polypharmacy: 29.7%;
      • hyperpolypharmacy: 41.3%.

The highest score for each behaviour was inversely associated with all-cause mortality in all 3 medication groups. The highest HBS was associated with a substantial benefit in all groups compared with lowest HBS:

      • no polypharmacy: HR 0.52 (95% CI 0.45–0.61);
      • polypharmacy: HR 0.55 (95% CI 0.49–0.63);
      • hyperpolypharmacy: HR 0.69 (95% CI 0.58–0.82).

“We have long known about the benefits of a healthy lifestyle,” Dr Kelly said. “The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications.”

    1. Kelly N, et al. Healthy Lifestyle is Inversely Associated With All-Cause Mortality Irrespective of Medication Burden. P929, AHA Scientific Sessions 2020, 13–17 Nov.


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