Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 12, 2026
Date Accepted: Aug 5, 2026
Healthy lifestyle score and the risk of cardiovascular disease, cancer and mortality in an Asian population: a prospective cohort study
ABSTRACT
Background:
Healthy lifestyle behaviors are key modifiable factors for the prevention of chronic diseases and premature mortality. Composite lifestyle scores provide a practical framework for capturing the combined impact of multiple health behaviors, but prospective evidence from multiethnic Asian populations remains limited.
Objective:
This study examined the associations of a composite healthy lifestyle score and the risk of cardiovascular diseases, cancer, and all-cause mortality, in a multiethnic Asian population.
Methods:
We analyzed prospective data from 9,920 participants of the Singapore Multi-Ethnic Cohort, who were free of major chronic diseases at baseline. A healthy lifestyle score was constructed from five components: body mass index, smoking, physical activity, diet quality, and screen time. Scores ranged from 0 to 10, with higher scores reflecting healthier lifestyles. An expanded score including mental well-being was examined in a subset. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using the Cox proportional hazards model for acute myocardial infarction (AMI), stroke, cancer and all-cause mortality, adjusting for sociodemographic factors, energy intake, family history of cancer or heart diseases, and menopause status.
Results:
During a median follow-up of 14 years, 457 AMI, 322 stroke cases, 707 cancer incident cases and 631 deaths were identified. More favorable lifestyle scores were associated with lower risk of cardiovascular outcomes and mortality consistent with a dose-response relationship. Compared to participants scoring 8-10, those with the lowest score (0-3) had more than two times the risk of AMI (HR=2.13; 95% CI=1.47-3.07), stroke (HR=3.21; 95% CI=2.12-4.85), and all-cause mortality (HR=2.01; 95% CI=1.46-2.78). In contrast, no significant associations were observed for cancer incidence. Incorporating mental well-being in the lifestyle score yielded similar results.
Conclusions:
Adherence to a healthy lifestyle was associated with a lower risk of AMI, stroke and mortality in a multiethnic Asian cohort, highlighting the importance of integrated lifestyle approaches for chronic disease prevention.
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