Sci Rep. 2026 Jul 20. doi: 10.1038/s41598-026-63153-3. Online ahead of print.
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.
PMID:42477134 | DOI:10.1038/s41598-026-63153-3