• health services
• quality of healthcare
• risk factors

There is considerable evidence demonstrating that healthy lifestyle behaviours contribute substantially to cardiovascular health. Various population-based cohort studies have consistently demonstrated their protective effect. For instance, in the Health Professionals Follow-up Study,1 62% of all coronary events observed in more than 40 000 men were found to be preventable through the optimal adherence to healthy lifestyle behaviours. In the Nurses’ Health Study,2 82% of all coronary events among 84 129 women were attributable to lack of adherence to a ‘low-risk’ pattern of behaviour, involving a healthy diet, regular exercise and abstinence from smoking. Furthermore, in over 50 000 participants pooled from four population-based studies,3 adherence to healthy behaviours was found to nearly halve the risk of coronary events among participants with high genetic predisposition for cardiovascular disease.

In accordance with this evidence, the American Heart Association’s (AHA) 2010 definition of ‘ideal cardiovascular health’ integrates the presence of four healthy behaviours: abstinence from smoking, ideal body mass index, regular physical activity and a healthy diet; alongside three ‘health factors:’ untreated total cholesterol <200 mg/dL (<5 mmol/L), untreated blood pressure <120/80 mm Hg and fasting blood glucose <100 mg/dL (<5.5 mmol/L). However, the association of the duration of being in ‘ideal cardiovascular health’ status and improved cardiovascular disease outcomes remains underexplored. Furthermore, it is not clear whether attainment of optimal lifestyle behaviours has concurrent protective benefits for other health conditions, such as chronic kidney disease, which share common risk factors with cardiovascular disease.

Cho and colleagues4 present the results of a study aimed …