Changes in health behaviors and risk of cardiovascular disease among midlife and aging municipal employees with and without metabolic risk factors: A register-linkage cohort study in Finland

OBJECTIVE: To investigate associations between changes in health behaviors and cardiovascular disease (CVD) risk among municipal employees, stratified by baseline metabolic risk factors (hypertension, hypercholesterolemia, obesity, diabetes). METHODS: We followed 4470 municipal employees in Helsinki, Finland (74 % women; median age 56.1 years) for an average of 11 years (2007-2022) to assess incident CVD. Survival curves estimated median survival differences, and hazard ratios (HRs) evaluated CVD risk related to changes in smoking, physical activity, alcohol consumption, diet, and sleep. RESULTS: During the follow-up, 1879 (42 %) individuals developed CVD. Among those without metabolic risk factors, improvement in health behavior score was linked to reduced CVD risk and an 8.1-year longer median survival (HR = 0.59, 95 % CI = 0.41-0.86). Across metabolic risk-factor groups, the most considerable reductions were observed in the transition from physical inactivity to activity among individuals with hypertension (HR = 0.66, 95 % CI = 0.49-0.87), diabetes (HR = 0.51, 95 % CI = 0.30-0.87), and obesity (HR = 0.63, 95 % CI = 0.43-0.93). CONCLUSIONS: Changes in health behaviors were associated with CVD risk, varying by metabolic factors. Findings support targeted interventions to promote behavior change, particularly increasing physical activity in those with metabolic risks.