Holistic Lifestyle Framework to Longitudinally Evaluate Cardiovascular Disparities and Post-Diagnosis Changes Among Older Thai Adults.

BACKGROUND

Lifestyle medicine is expanding across Asia to address cardiovascular disease (CVD) in aging populations, but evidence from rapidly aging Thailand on holistic lifestyle patterns and post-diagnosis behavior change is limited.

OBJECTIVES

Using a multidomain framework, the authors examined sociodemographic disparities in lifestyle behaviors, links between individual/cumulative unhealthy behaviors and CVD prevalence/incidence, and post-diagnosis behavior change among older Thai adults.

METHODS

We analyzed 8,086 adults ≥45 years of age in the HART (Health, Aging, and Retirement in Thailand) cohort (2015-2022). Five American College of Lifestyle Medicine domains were assessed including leisure-time physical activity (LTPA), alcohol/smoking, sleep, stress management, and social engagement. Logistic/log-Poisson regression models estimated associations with prevalent/incident CVD; generalized estimating equations assessed post-diagnosis change. Models were covariate-adjusted with inverse probability weighting. Incident CVD was secondary because of short, variable follow-up from many 2022 entrants (median: 0 years [Q1-Q3: 0-7 years]; mean: 2.5 ± 3.1 years).

RESULTS

Prevalent CVD affected 745 of 8,086 (9.2%) participants; 205 developed incident CVD. Low LTPA was common, and sleep/stress management worsened over time. Low LTPA and social disengagement were more frequent among older, rural, and lower-income adults, whereas smoking and alcohol use were higher among men and higher-income groups. Having ≥3 unhealthy behaviors was associated with greater odds of prevalent CVD (OR: 1.82; 95% CI: 1.35-2.48). Poor stress management independently predicted prevalent CVD (OR: 1.44; 95% CI: 1.04-1.96), and former smoking predicted incident CVD (risk ratio: 1.99; 95% CI: 1.14-3.48). Post-diagnosis, LTPA was least likely to improve.

CONCLUSIONS

Holistic attention to behavioral risks is essential; lifestyle medicine can play an expanded role in CVD management. Tailored, equity-sensitive strategies are needed to support recovery and healthy aging after diagnosis.