J Prev Med Public Health.  2013 Nov;46(6):319-328.

Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study

  • 1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. yoahn@snu.ac.kr
  • 2Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
  • 3Department of Social Medicine, Hallym University College of Medicine, Chuncheon, Korea.
  • 4Department of Preventive Medicine, Cheju National University College of Medicine, Jeju, Korea.
  • 5Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
  • 6Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea.
  • 7Department of Epidemiology and Statistics, School of Public Health Sciences, Jilin University, Changchun, China.
  • 8Korean Foundation for Cancer Research, Seoul, Korea.


This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea.
In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics.
There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality.
Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.


Cardiovascular diseases; Cohort studies; Cox proportional hazards models; Life style; Mortality

MeSH Terms

Blood Glucose/analysis
Blood Pressure
Body Mass Index
Cardiovascular Diseases/epidemiology/*mortality
Cohort Studies
Follow-Up Studies
Kaplan-Meier Estimate
Life Style
Middle Aged
Republic of Korea/epidemiology
Risk Factors
Blood Glucose
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