Our studeis had several strengths. TWsHHH as an population of middle-age adult with low prevalence of clinicla risk factors was national representative cohort with little loss to follow-up over 13.5 years. Furthermore, the cohort contained detailed assessment both of lifestyle factors and the direct measures of clinical risk factors and biomarkers. The benefit from healthy lifestyle score on CVD risk were robust after the adjustment of clinical factors. Second, the protectvion from healthy lifestyle score and Mediterranean diet pattern on CVD risk were validated in Asia population. The healthy lifestyle scores as an primodrial preventive policy to response 2025 global target of WHO amonog western countries extending to asia population. Additionally,
to our knowledge, this is the first estimation of the CVD risk specifically from WCRF/AICR recommended lifestyle score. The first study compared different
healthy lifestyle scores on CVD incidence and including biomakers considering in the model improved the discriminatory ability. Finally, age as effect modifier among the association among healthy lifestyle scores and the incidence of CVD were
demonstrated by the primary data validation.
Nonetheless, several study limitations should be mentioned. The Taiwan healthy lifestyle score were assessed with TWsHHH cohort but lack external data validation.
Further confirmation should be considered with other asia population. Additional, lifestyle factors recorded at baseline without repeated assessments had potential non-differential misclassification in the study. Nevertheless, if the association between healthy lifestyle score and the risk of CVD were significant with misclassification bias, the true relative risk between them should be more effective with respect to subsequent repeated measurements of exposure. Finally, although Mediaterranean were demonstrated reducing the incidence of CVD significantly, the western diet score might not be suitable for Asia diet pattern. Development of Asia healthy diet score improved the difference.
Chapter Five：Conclusion
In conclusion, adherence to high numbers of combined healthy lifestyle scores plays an important role in the primary prevention of CVD, especially in younger adult with low short-term risk. Simple and weighted Taiwan healthy lifestyle scores can be more effective and predictable of CVD reduction than WCRF/AICR lifestyle score and Life's Simple 7 in adult Taiwanese population. Further investigation of the
mechanism of CVD prevention from healthy lifestyle independent to clinical factors
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