Can combined lifestyle behaviours refine cardiovascular risk assessment? A prospective cohort analysis from the UK Biobank, published in the European Journal of Preventive Cardiology, examined the multi-behaviour associations of sleep, physical activity, and nutrition (SPAN) with major adverse cardiovascular events (MACE), including myocardial infarction (MI), heart failure (HF), and stroke.

The analysis included 53, 242 participants (median age: 63.0 years; 56.8% male). Wearable-measured sleep (h/day) and moderate to vigorous physical activity (MVPA; min/day) were calculated using a machine learning-based algorithm, and diet was assessed using a 10-item diet quality score (DQS).

The analysis categorized participants across 27 joint tertile combinations of SPAN behaviors, and a composite SPAN score (0-100) was used to assess dose-response associations. Over an 8.0-year follow-up, 2034 MACE events occurred, including 932 MI, 584 strokes, and 518 HF events. Compared with the lowest tertile for all SPAN behaviours, the optimal SPAN combination of 8.0-9.4 h/day sleep, 42-104 min/day MVPA, and a DQS of 32.5-50.0 was associated with a 57% lower risk of MACE (HR: 0.43; 95% CI: 0.30, 0.62).

A median SPAN score (52.8) was associated with a 41% lower risk of MACE (HR: 0.59; 95% CI: 0.49, 0.70). The median SPAN score corresponded to an HR of 0.53 (0.38, 0.75) for HF, 0.65 (95% CI: 0.50, 0.84) for MI, and 0.52 (95% CI: 0.38, 0.71) for stroke. A minimum combined variation of an additional 11 min/day of sleep, 4.5 min/day MVPA, and 3 DQS points was associated with 10% lower MACE risk (HR: 0.90; 0.88, 0.94).

No synergistic interaction between SPAN behaviours and MACE was observed (RERI = 0.003; 95% CI: -0.03, 0.04; AP = 0.4%; 95% CI: -6 to 7%; S = 1.03; 95% CI: -3.32, 5.29). These findings indicate that modest differences in combined SPAN behaviour levels were associated with meaningful reductions in MACE risk.