Healthy Lifestyle Associated With Lower All-Cause Mortality Regardless of Polypharmacy

mediterranean diet, fish, nutrition
mediterranean diet, fish, nutrition
A healthy lifestyle was found to be inversely associated with all-cause mortality, regardless of polypharmacy.

This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

A healthy lifestyle was found to be inversely associated with all-cause mortality, regardless of polypharmacy, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.1

In this study, data of participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were examined. The impact on all-cause mortality of exposure to 4 behaviors considered as healthy was assessed. These behaviors, which were scored from 0 to 2, in which 0 indicated low adherence and 2 indicated high adherence, were the following: adherence to a Mediterranean diet, physical activity, smoking abstinence, and sedentary lifestyle avoidance (ie, low TV time). The impact of the cumulative Health Behavior Score (HBS), which was based on the sum of individual behavior scores (range, 0-8 on all-cause mortality, the study’s main outcome was also examined.

Cox proportional hazards models were estimated for each medication burden stratum (0-4 medications at baseline: no polypharmacy; 5-9 medications: polypharmacy; and ≥10 medications: hyperpolypharmacy) and were adjusted for sociodemographics, health status, comorbid conditions, and medication adherence.

The data of 20,417 participants (mean age, 64.8±9.2 years; 56% women) were examined, with an average of 9.8±3.8 years of follow-up. At baseline, 44% of participants had no polypharmacy, 39% had polypharmacy, and 17% had hyperpolypharmacy. All-cause mortality was found to increase with increasing medication burden (no polypharmacy, 19.1%; polypharmacy, 29.7%; and hyperpolypharmacy, 41.3%).

The highest score for each behavior was inversely associated with all-cause mortality in all 3 strata. In addition, the highest HBS for all 3 strata was associated with substantial benefit: no polypharmacy (hazard ratio [HR,] 0.52; 95% CI, 0.45-0.61); polypharmacy (HR, 0.55; 95% CI, 0.49-0.63); and hyperpolypharmacy (HR, 0.69; 95% CI, 0.58-0.82).

“We’ve long known about the benefits of leading a healthy lifestyle,” noted lead author, Neil Kelly, PhD, a medical student at Weill Cornell Medicine of Cornell University in New York City, New York.2 “The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications.”

Dr Kelly recommends that healthcare professionals counsel patients, including those taking several prescription medications, and develop interventions that can maximize healthy lifestyle behaviors.

“It’s important for the public to understand that there is never a bad time to adopt healthy behaviors,” he noted. “These can range from eating a healthier diet to taking a daily walk in their neighborhood. A healthier lifestyle buys more time.”

Disclosures: One of the study authors reported an affiliation with a biotechnology company. Please see the original reference for a full list of disclosures.


  1. Kelly N, Soroka O, Onyebeke C, et al. Healthy lifestyle is inversely associated with all-cause mortality irrespective of medication burden. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation P929.
  2. Healthy habits are key to maintaining health even while taking multiple prescriptions [press release]. Dallas, Texas: American Heart Association; November 9, 2020.

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