{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:05Z","timestamp":1787018105583,"version":"build-2736575974"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A lifestyle comprising a healthy diet, light alcohol consumption, no smoking, and moderate or intense physical activity has been associated with reduced risk of cardiovascular disease (CVD). We examined the association of a healthy lifestyle index (HLI), derived from scores for each of these components plus waist circumference, with the risk of incident CVD and CVD subtypes in postmenopausal women with normal body mass index (18.5\u2013&lt;25.0\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We studied 40\u2009118 participants in the Women's Health Initiative, aged 50 to 79\u2009years at enrollment, with a normal body mass index and no history of CVD. The HLI score was categorized into quintiles. We estimated multivariable adjusted hazard ratios (HR) and 95% CIs for the association of HLI with risk of CVD and CVD subtypes using Cox regression models. A total of 3821 cases of incident CVD were ascertained during a median follow\u2010up of 20.1\u2009years. Compared with the lowest quintile (unhealthiest lifestyle), higher HLI quintiles showed inverse associations with the risk of CVD (HR\n                      <jats:sub>\n                        <jats:italic>quintile\u22122<\/jats:italic>\n                      <\/jats:sub>\n                      =0.74 [95% CI, 0.67\u20130.81]; HR\n                      <jats:sub>\n                        <jats:italic>quintile\u22123<\/jats:italic>\n                      <\/jats:sub>\n                      =0.66 [95% CI, 0.60\u20130.72]; HR\n                      <jats:sub>\n                        <jats:italic>quintile\u22124<\/jats:italic>\n                      <\/jats:sub>\n                      =0.57 [95% CI, 0.51\u20130.63]; and HR\n                      <jats:sub>\n                        <jats:italic>quintile\u22125<\/jats:italic>\n                      <\/jats:sub>\n                      =0.48 [95% CI, 0.43\u20130.54],\n                      <jats:italic>P\u2010trend<\/jats:italic>\n                      =&lt;0.001). HLI was also inversely associated with risks of stroke, coronary heart disease, myocardial infarction, angina, and coronary revascularization. Subgroup analyses, stratified by age (\u226463 years vs &gt;63\u2009years), body mass index (&lt;\/\u2265\u200922.0\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), and general health status (absence\/presence of hypertension, diabetes, or lipid\u2010lowering drug use) also showed inverse associations between HLI and risk of CVD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among postmenopausal women with a normal body mass index, adherence to a healthy lifestyle is associated with a reduced risk of clinical CVD and CVD subtypes, underscoring the cardiovascular benefits of maintaining a healthy lifestyle, even for women with a healthy weight.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.029111","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T06:30:20Z","timestamp":1686551420000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Healthy Lifestyle Index and Risk of Cardiovascular Disease Among Postmenopausal Women With Normal Body Mass Index"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1784-7921","authenticated-orcid":false,"given":"Rita","family":"Peila","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaonan","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2687-1758","authenticated-orcid":false,"given":"Qibin","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1901-6497","authenticated-orcid":false,"given":"Andrew J.","family":"Dannenberg","sequence":"additional","affiliation":[{"name":"Emerald Bioventures NY New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0777-8272","authenticated-orcid":false,"given":"Matthew A.","family":"Allison","sequence":"additional","affiliation":[{"name":"Family Medicine and Public Health University of California CA San Diego USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3493-4077","authenticated-orcid":false,"given":"Karen C.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine The University of Tennessee TN Memphis USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6669-5242","authenticated-orcid":false,"given":"Michael J.","family":"LaMonte","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health University of Buffalo NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1298-265X","authenticated-orcid":false,"given":"Robert A.","family":"Wild","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Biostatistics and Epidemiology University of Oklahoma Health Sciences Center OK Oklahoma City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Haring","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Heart Center Graz, Medical University of Graz Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Kaiser Permanente Southern California CA Downey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary A.","family":"Tindle","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center TN Nashville USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9255-9394","authenticated-orcid":false,"given":"Randi","family":"Foraker","sequence":"additional","affiliation":[{"name":"Department of Medicine Washington University at St. Louis MO St. Louis USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2819-2839","authenticated-orcid":false,"given":"Nazmus","family":"Saquib","sequence":"additional","affiliation":[{"name":"College of Medicine at Sulaiman Al Rajhi University Bukariyah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9935-8904","authenticated-orcid":false,"given":"Ana","family":"Barac","sequence":"additional","affiliation":[{"name":"MedStar Heart and Vascular Institute Georgetown University DC Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Rohan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Albert Einstein College of Medicine, Bronx NY New York City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000678"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcl085"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.117.308903"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.237"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.109.192703"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.0022"},{"key":"e_1_3_2_8_2","volume-title":"The Health Consequences of Smoking\u201450\u2009Years of Progress: A Report of the Surgeon General","author":"National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General","year":"2014","unstructured":"National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General . The Health Consequences of Smoking\u201450\u2009Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention (US); 2014."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2004.02.007"},{"key":"e_1_3_2_10_2","first-page":"7","article-title":"Abdominal obesity and cardiovascular disease risk factors within body mass index categories","volume":"23","author":"Shields M","year":"2012","unstructured":"Shields M, Tremblay MS, Connor Gorber S, Janssen I. Abdominal obesity and cardiovascular disease risk factors within body mass index categories. Health Rep. 2012;23:7\u201315.","journal-title":"Health Rep"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyw319"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f6879"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000510"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.109.924977"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.115.306883"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000677"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.04.046"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-214050"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.11.043"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz391"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1047-2797(98)00055-6"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2013.08.018"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn.82.3.651"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31818ace55"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-199301000-00011"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j909"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-022-01558-x"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34034"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1047-2797(03)00048-6"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1037\/1040-3590.15.2.137"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000107251.49515.c2"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp107"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0000000000001360"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000367"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/hyp.0000000000000066"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00561.x"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.07.039"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.14797\/mdcj-13-4-185"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm200008243430802"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.124865"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12433"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.067264"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2017.289"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/80.4.1029"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2015.12.004"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1520-037x.2004.03539.x"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.Atv.0000079512.66448.1d"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040967"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.029111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T08:46:17Z","timestamp":1715589977000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.029111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,20]]},"references-count":47,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,6,20]]}},"alternative-id":["10.1161\/JAHA.122.029111"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.029111","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,20]]},"assertion":[{"value":"2022-12-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e029111"}}