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.