Abstract / Summary
Abstract Aims Sudden cardiac arrest (SCA) is a major public health issue with high mortality and limited prevention. This study investigated the association between lifestyle factors and SCA risk, and the impact of lifestyle on post-SCA mortality, with major adverse cardiovascular events (MACE) as intermediate factors. Methods and results This population-based cohort study included 404,970 UK Biobank participants. A healthy lifestyle score (0–7) was constructed from seven factors: smoking, alcohol, physical activity, diet, sleep, sedentary behavior, and social connection, and categorized as unfavorable (0–1), moderate (2–4), or favorable (5–7). Over a median follow-up of 13.5 years, 2,294 SCA cases occurred. Each additional healthy lifestyle factor was associated with a 13% reduced SCA risk (HR = 0.87, 95% CI: 0.84–0.90, P = 6.54×10 − 16 ). Compared to an unfavorable lifestyle, favorable lifestyle was linked to a 64% lower SCA risk (HR = 0.36, 95% CI: 0.28–0.46, P = 1.88×10 − 15 ). Using multi-state models, each one-point increase in lifestyle score reduced the transition from MACE to MACE + SCA by 8% (HR = 0.92, 95% CI: 0.88–0.96, P = 1.87×10 − 4 ), and reduced post-SCA mortality by 9% (HR = 0.91, 95% CI: 0.86–0.97, P = 0.002). Conclusion A healthy lifestyle is associated with reduced SCA incidence and improved survival after SCA, offering insights for prevention and early intervention.