Objective To investigate the association between healthy lifestyle factors and cardiovascular biological aging, as well as the relative contributions of different lifestyle factors.

Methods Based on the clinical biochemical data and anthropometric data from the baseline survey of the UK Biobank (UKB), the Klemera-Doubal method (KDM) was used to establish cardiovascular biological age (CBA), and CBA acceleration was calculated accordingly. Multiple linear regression models were used to estimate the associations between healthy lifestyle factors and CBA acceleration. Then, the Quantile g-computation (QGC) was applied to evaluate the relative contributions of different lifestyle factors to CBA acceleration, with further analyses conducted separately for male and female populations. Additionally, stratified analyses were performed based on age, sex, body mass index (BMI), racial background, and family history of cardiovascular diseases to examine population heterogeneity.

Results A total of 251478 participants were included in the study. Both the overall healthy lifestyle score and each of the 7 lifestyle factors were negatively associated with CBA acceleration (overall lifestyle score: β = －0.75, 95% CI: －0.77 to －0.73). Regarding the relative contributions of different lifestyle factors, alcohol consumption and diet accounted for the highest proportions (25.8% and 25.7%, respectively). However, there were differences by sex—alcohol consumption contributed the most in men (29.5%), followed by diet (23.0%), while in women, diet contributed the most (34.5%) and alcohol consumption accounted for a relatively low proportion (5.5%). Stratified analyses suggested that sex, BMI, and race might be potential effect modifiers.

Conclusion Lifestyle factors, as modifiable behaviors, can slow the rate of cardiovascular biological aging. Among these factors, alcohol consumption and diet may represent effective targets for intervention.