Health factors have the power to prevent and postpone diseases and death; however, studies using the same methodology in both men and women are sparse. We aimed to study the ability of health factors to prevent mortality in a population-based, 26-year follow-up of Swedish men and women. During 1969–70, a health-screening programme was offered to a stratified sample of 3,064 individuals aged 18–64 years to estimate health-care needs. Missing data (largely according to protocol) for physical fitness, BMI, and smoking habits left 935 subjects, 463 men and 472 women. Alcohol consumption in grams per week and BMI was calculated. Tobacco smoking was recorded as yes/no. Multivariate analysis was performed by Cox regression with age adjusted hazard ratios (HR) and 95% confidence interval (CI). Moderate alcohol consumption did not lead to any decrease in mortality. Having two health factors halved the mortality risk in men and women (hazard ratio (HR) 0.52, confidence interval (CI) 0.39–0.70). A further risk reduction was seen in men with three health factors (HR 0.17, CI 0.074–0.41). Men had about 70 per cent higher risk of mortality compared with women after adjustments for all health factors (HR 1.67, CI 1.26–2.23). Men compared to women had greater benefit of all three health factors. This in combination with the overall higher mortality risk in men makes a healthy lifestyle more important for them. The benefit of moderate alcohol consumption could not be detected in this study, and may be explained by an unhealthy drinking pattern in Sweden.
Body mass index Alcohol consumption Tobacco smoking Physical fitness Health factors Mortality
Body mass index
This is a preview of subscription content, log in to check access.
The study was supported by the Stockholm County Council.
Jiao L, Mitrou PN, Reedy J, et al. A combined healthy lifestyle score and risk of pancreatic cancer in a large cohort study. Arch Intern Med. 2009;169:764–70.CrossRefPubMedGoogle Scholar
Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.CrossRefPubMedGoogle Scholar
Akesson A, Weismayer C, Newby PK, Wolk A. Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Arch Intern Med. 2007;167:2122–7.CrossRefPubMedGoogle Scholar
Djousse L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302:394–400.CrossRefPubMedGoogle Scholar
Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302:401–11.CrossRefPubMedGoogle Scholar
Britton A, Marmot MG, Shipley M. Who benefits most from the cardioprotective properties of alcohol consumption—health freaks or couch potatoes? J Epidemiol Community Health. 2008;62:905–8.CrossRefPubMedGoogle Scholar
Mukamal KJ, Chiuve SE, Rimm EB. Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles. Arch Intern Med. 2006;166:2145–50.CrossRefPubMedGoogle Scholar
Carlsson AC, Theobald H, Hellenius ML, Wandell PE. Cardiovascular and total mortality in men and women with different blood pressure levels—A 26-year follow-up. Blood Press. 2009;18(3):105–110.CrossRefGoogle Scholar
Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes (Lond). 2009;33:577–82.CrossRefGoogle Scholar
Wandell PE, Carlsson AC, Theobald H. Effect of heart-rate recovery on long-term mortality among men and women. Int J Cardiol. 2009. doi:10.1016/j.ijcard.2009.01.053.
Theobald H, Bygren LO, Carstensen J, Engfeldt P. Validity of two questions on alcohol use in a health survey questionnaire. Scand J Public Health. 1999;27:73–7.CrossRefPubMedGoogle Scholar
Greenfield JR, Samaras K, Jenkins AB, Kelly PJ, Spector TD, Campbell LV. Moderate alcohol consumption, estrogen replacement therapy, and physical activity are associated with increased insulin sensitivity: is abdominal adiposity the mediator? Diabetes Care. 2003;26:2734–40.CrossRefPubMedGoogle Scholar
Wandell PE, de Faire U, Hellenius ML. High intake of alcohol is associated with newly diagnosed diabetes in 60 years old men and women. Nutr Metab Cardiovasc Dis. 2007;17:598–608.CrossRefPubMedGoogle Scholar
Theobald H, Wandell PE. Effect of heart rate on long-term mortality among men and women. Acta Cardiol. 2007;62:275–9.CrossRefPubMedGoogle Scholar
Li C, Engstrom G, Hedblad B, Janzon L. Sex-specific cardiovascular morbidity and mortality in a cohort treated for hypertension. J Hypertens. 2006;24:1523–9.CrossRefPubMedGoogle Scholar
Burger M, Mensink G, Bronstrup A, Thierfelder W, Pietrzik K. Alcohol consumption and its relation to cardiovascular risk factors in Germany. Eur J Clin Nutr. 2004;58:605–14.CrossRefPubMedGoogle Scholar
Caimi G, Carollo C, Lo Presti R. Wine and endothelial function. Drugs Exp Clin Res. 2003;29:235–42.PubMedGoogle Scholar
de Lange DW, van de Wiel A. Drink to prevent: review on the cardioprotective mechanisms of alcohol and red wine polyphenols. Semin Vasc Med. 2004;4:173–86.CrossRefPubMedGoogle Scholar
Messner T, Petersson B. Alcohol consumption and ischemic heart disease mortality in Sweden. Scand J Soc Med. 1996;24:107–13.PubMedGoogle Scholar
Carlsson AC, Wandell PE, de Faire U, Hellenius ML. Prevalence of hypertension in immigrants and Swedish-born individuals, a cross-sectional study of 60-year-old men and women in Sweden. J Hypertens. 2008;26:2295–302.CrossRefPubMedGoogle Scholar
Carlsson AC, Wandell PE, de Faire U, Hellenius ML. Risk factors associated with newly diagnosed high blood pressure in men and women. Am J Hypertens. 2008;21:771–7.CrossRefPubMedGoogle Scholar
Parekh RS, Klag MJ. Alcohol: role in the development of hypertension and end-stage renal disease. Curr Opin Nephrol Hypertens. 2001;10:385–90.CrossRefPubMedGoogle Scholar
Stranges S, Wu T, Dorn JM, et al. Relationship of alcohol drinking pattern to risk of hypertension: a population-based study. Hypertension. 2004;44:813–9.CrossRefPubMedGoogle Scholar
Bagnardi V, Zatonski W, Scotti L, La Vecchia C, Corrao G. Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis. J Epidemiol Community Health. 2008;62:615–9.CrossRefPubMedGoogle Scholar
Clarke R, Emberson J, Fletcher A, Breeze E, Marmot M, Shipley MJ. Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study. BMJ. 2009;339:b3513.CrossRefPubMedGoogle Scholar
Theobald H, Bygren LO, Carstensen J, Hauffman M, Engfeldt P. Effects of an assessment of needs for medical and social services on long-term mortality: a randomized controlled study. Int J Epidemiol. 1998;27:194–8.CrossRefPubMedGoogle Scholar