Purpose. We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the associated population attributable fractions (PAFs) of these factors. Methods. Slightly modified AHA cardiovascular health factors (smoking, body mass index, cardiorespiratory fitness, and diet) were measured among 11,240 (24% women) participants from the Aerobics Center Longitudinal Study between 1987 and 1999. The cohort was followed to December 31, 2003, or death. PAFs were calculated as the proportionate reduction in death attributable to identified risk factors. Results. During an average 12 years of followup, 268 deaths occurred. Low fitness had the highest PAFs at the 5th, 10th, and 15th year of followup, respectively: 6.6%, 6.4%, and 5.5%. Current smokers had the second highest PAFs at the 5th, 10th, and 15th year of followup, respectively: 5.4%, 5.2%, and 5.0%. Additional adjusting for other confounders in the model did not change the above associations. The PAFs for overweight or obesity and unhealthy diet were not significant in the current analyses. Conclusions. Assuming a causal relationship between smoking, low fitness, and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity. 1. Introduction Cardiovascular disease (CVD) continues to be the leading cause of death in the United States with an average of 1 death every 39 seconds and an estimated direct and indirect cost of $286.6 billion [1]. Recently, the American Heart Association (AHA) 2020 Impact Goal defined a new construct of cardiovascular health behavior for adults and children based on 4 lifestyle factors (smoking, body mass index (BMI), physical activity, and diet) and set national goals for promoting cardiovascular health and reducing CVD burden [2]. Previous studies consistently show an inverse association between multiple low-risk lifestyle factors and all-cause mortality [3–7]; however, widely varying definitions of the lifestyle factors are applied in these studies. To date, only two studies have used AHA cardiovascular health behavior concept to define the 4 lifestyle factors [8, 9]. Bambs and colleagues addressed the prevalence of the new AHA metrics that define cardiovascular lifestyle factors and reported that 81% of all participants in the community-based Heart SCORE study presented ≤3 ideal lifestyle factors (nearly 60% presented zero or one ideal factor) [8]. In an ideal world with
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