A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease (CVD) prevention. However, despite their interlinked effects on metabolic health, the 2 behaviors are rarely considered jointly, particularly within the context of CVD prevention. We examined the independent, interactive, and joint associations of diet and physical activity with CVD hospitalization, CVD mortality, and all-cause mortality. CVD-free Australian participants aged 45–74 years ( = 85,545) reported physical activity, diet, and sociodemographic and lifestyle characteristics at baseline (2006–2009) and follow-up (2012–2015), and data were linked to hospitalization and death registries (03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality). Diet quality was categorized as low, medium, and high based on meeting dietary recommendations. Physical activity was operationalized as (a) total moderate-to-vigorous physical activity (MVPA) as per guidelines, and (b) the composition of MVPA as the ratio of vigorous-intensity physical activity (VPA) to total MVPA. We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates. During a median of 10.7 years of follow-up, 6576 participants were admitted to the hospital for CVD and 6581 died from all causes (876 from CVD during 9.3 years). A high-quality diet was associated with a 17% lower risk of all-cause mortality than a low-quality diet, and the highest MVPA category (compared with the lowest) was associated with a 44% and 48% lower risk of CVD and all-cause mortality, respectively. Multiplicative interactions between diet and physical activity were non-significant. For all outcomes, the lowest risk combinations involved a high-quality diet and the highest MVPA categories. Accounting for total MVPA, some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality. For CVD prevention and longevity, one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

中文翻译：

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85,545 名澳大利亚老年人的饮食质量和体力活动与心血管疾病和死亡率的关系：一项纵向研究


优质饮食和积极的生活方式都是预防心血管疾病（CVD）的重要基石。然而，尽管这两种行为对代谢健康具有相互关联的影响，但很少将这两种行为结合起来考虑，特别是在预防心血管疾病的背景下。我们研究了饮食和体力活动与 CVD 住院、CVD 死亡率和全因死亡率之间的独立、交互和联合关系。年龄为 45-74 岁的无 CVD 澳大利亚参与者 (=85,545) 报告了基线 (2006-2009) 和随访 (2012-2015) 时的体力活动、饮食、社会人口学和生活方式特征，并且数据与住院和死亡相关登记处（CVD 住院和全因死亡率为 2019 年 3 月 31 日，CVD 死亡率为 2017 年 12 月 8 日）。根据是否符合饮食建议，饮食质量分为低、中、高。体力活动可操作为 (a) 根据指南的总中度至剧烈体力活动 (MVPA)，以及 (b) MVPA 的构成，即剧烈强度体力活动 (VPA) 与总 MVPA 的比率。我们使用时变协变量的左截断特定原因 Cox 比例风险模型。在平均 10.7 年的随访期间，6576 名参与者因 CVD 入院，6581 名参与者因各种原因死亡（9.3 年内有 876 名参与者死于 CVD）。与低质量饮食相比，高质量饮食与全因死亡风险降低 17% 相关，最高 MVPA 类别（与最低 MVPA 类别相比）与 CVD 和 CVD 风险降低 44% 和 48% 相关。分别为全因死亡率。饮食和体力活动之间的乘法相互作用不显着。 对于所有结果，最低风险组合涉及高质量饮食和最高 MVPA 类别。考虑到总 MVPA，一些 VPA 与进一步降低 CVD 住院和全因死亡率风险相关。为了预防 CVD 和长寿，人们应该坚持健康的饮食和积极的生活方式，并在可能的情况下加入一些 VPA。