Unhealthy lifestyle and cardiovascular disease risk in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study
- 1Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine
- 2Department of Statistics and Actuarial Science, Soongsil University
Abstract
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in older adults, yet most prevention strategies target midlife populations. The association of unhealthy lifestyle behaviors on CVD risk in adults aged 75 and older remains unclear. We analyzed the Korean National Health Insurance Service (NHIS) database (2012–2015) for adults aged ≥ 75 years without prior CVD. The Unhealthy Lifestyle Behavior Score (ULBS) quantified risk by assigning one point each for current smoking, heavy drinking, and non-regular exercise. Fine and Gray’s models estimated hazard ratios (HRs) for incident CVD, considering death as a competing risk. Among 869,781 participants (mean age 78.5 years, 41.7% male), participants were followed for a mean of 6.7 years (until December 31, 2022). A total of 120,353 incident CVD events (55,117 myocardial infarction (MI), 74,001 stroke) occurred. The incidence rates of CVD per 1,000 person-years were 17.09, 20.64, 28.80, and 30.64 for ULBS 0, 1, 2, and 3, respectively. Compared to ULBS 0, higher scores were associated with an increased CVD risk, with adjusted HRs of 1.173 (95% confidence interval [CI]: 1.153–1.194) for 1, 1.481 (95% CI: 1.445–1.519) for 2, and 1.528 (95% CI: 1.437–1.626) for 3. Similar trends were noted for MI and stroke. Unhealthy lifestyle behaviors are significantly associated with an increased cardiovascular risk in the adults aged 75 years and older. These findings underscore that targeted primary prevention—particularly smoking cessation and physical activity promotion—remains a highly relevant priority well beyond midlife.
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BibTeX
@article{choi2026unhealthy,
title = {{Unhealthy lifestyle and cardiovascular disease risk in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study}},
author = {Sangwon Choi and Kyung Do Han and Kyung-Ho Yu and Byung Chul Lee and Minwoo Lee and Mi Sun Oh},
journal = {Scientific Reports},
year = {2026},
month = jul,
doi = {10.1038/s41598-026-63153-3},
url = {https://doi.org/10.1038/s41598-026-63153-3},
note = {CC BY},
}
RIS
TY - JOUR
TI - Unhealthy lifestyle and cardiovascular disease risk in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study
AU - Sangwon Choi
AU - Kyung Do Han
AU - Kyung-Ho Yu
AU - Byung Chul Lee
AU - Minwoo Lee
AU - Mi Sun Oh
PY - 2026
DA - 2026/07/01
JO - Scientific Reports
DO - 10.1038/s41598-026-63153-3
UR - https://doi.org/10.1038/s41598-026-63153-3
AB - Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in older adults, yet most prevention strategies target midlife populations. The association of unhealthy lifestyle behaviors on CVD risk in adults aged 75 and older remains unclear. We analyzed the Korean National Health Insurance Service (NHIS) database (2012–2015) for adults aged ≥ 75 years without prior CVD. The Unhealthy Lifestyle Behavior Score (ULBS) quantified risk by assigning one point each for current smoking, heavy drinking, and non-regular exercise. Fine and Gray’s models estimated hazard ratios (HRs) for incident CVD, considering death as a competing risk. Among 869,781 participants (mean age 78.5 years, 41.7% male), participants were followed for a mean of 6.7 years (until December 31, 2022). A total of 120,353 incident CVD events (55,117 myocardial infarction (MI), 74,001 stroke) occurred. The incidence rates of CVD per 1,000 person-years were 17.09, 20.64, 28.80, and 30.64 for ULBS 0, 1, 2, and 3, respectively. Compared to ULBS 0, higher scores were associated with an increased CVD risk, with adjusted HRs of 1.173 (95% confidence interval [CI]: 1.153–1.194) for 1, 1.481 (95% CI: 1.445–1.519) for 2, and 1.528 (95% CI: 1.437–1.626) for 3. Similar trends were noted for MI and stroke. Unhealthy lifestyle behaviors are significantly associated with an increased cardiovascular risk in the adults aged 75 years and older. These findings underscore that targeted primary prevention—particularly smoking cessation and physical activity promotion—remains a highly relevant priority well beyond midlife.
SN - 2045-2322
ER -