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Effects of combined healthy lifestyle factors on functional vascular aging: the Rotterdam Study

Karimi, Leila; Mattace-Raso, Francesco U.S.; van Rosmalen, Joost; van Rooij, Frank; Hofman, Albert; Franco, Oscar H.

doi: 10.1097/HJH.0000000000000861

Objective: To evaluate whether components of a healthy lifestyle, combined and individually, are associated with arterial stiffness as a marker of functional vascular aging.

Methods: We included 3235 participants aged 61–96 years from the Rotterdam Study. Measures of arterial stiffness included: aortic pulse wave velocity and carotid distensibility coefficient. Participants were scored one point for each of healthy lifestyle factors: consumption of five or more of fruits and/or vegetables per day, 75 min or more vigorous physical activity per week, 18.5 ≤ BMI ≤ 24. 9, never smoked and light-to-moderate alcohol intake (maximum seven glasses for women and 14 glasses for men) per week. Also a combined score (0–5) was computed by adding the five factors. Linear regression analysis was used to evaluate the association of healthy lifestyle and measures of arterial stiffness adjusting for confounders.

Results: Participants had −0.113 [95% confidence interval (CI): −0.196, −0.029] difference in mean aortic pulse wave velocity m/s per unit increment of the lifestyle factors score, independent of cardiovascular risk factors. Higher fruit and vegetable consumption −0.221 (95% CI: −0.409, −0.034) and physical activity −0.239 (95% CI: −0.433, −0.044) were also significantly associated with reduced aortic pulse wave velocity. The corresponding estimates in carotid distensibility coefficient lacked statistical significance when we adjusted for cardiovascular risk factors.

Conclusion: Combining multiple healthy lifestyle factors is associated with reduced aortic stiffness, a measure of functional vascular aging and independent of cardiovascular risk factors.

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aDepartment of Epidemiology

bDepartment of Internal Medicine, Section of Geriatric Medicine

cDepartment of Biostatistics, Erasmus MC, Rotterdam, the Netherlands

Correspondence to Prof. Oscar H. Franco, MD, PhD, Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Office Na 29-16, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Tel: +31 10 70 43484; fax: +31 10 70 44657; e-mail:

Abbreviations: aPWV, aortic pulse wave velocity; carotid DC, carotid distensibility coefficient; HLF, healthy lifestyle factor; VPA, vigorous physical activity

Received 17 May, 2015

Revised 31 October, 2015

Accepted 21 December, 2015

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