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Background: Medicines complement healthy lifestyles in cardiovascular disease (CVD) prevention, but knowledge is lacking on how behaviours in these domains are related. This study aimed at investigating associations between physical activity and diet, and time to initiation of preventive medicines.

Method: A cohort study based on the "Visualization of Asymptomatic Atherosclerotic Disease for Optimal Cardiovascular Prevention" (VIPVIZA)-trial, including 60-year-olds of low/moderate CVD-risk who were treatment-naive to antihypertensives or lipid-lowering medicines six months prior trial-inclusion. Sex-specific Cox proportional hazards models were used to analyse impacts of diet and physical activity, each categorized in three levels (least healthy – moderately healthy – healthiest), on initiation of antihypertensives and lipid-lowering medicines.

Results: Of 1891 individuals in the cohort, 1340 (58% women) were antihypertensive-naive and 1783 (57% women) were lipid-lowering naive. Significantly faster initiation of antihypertensives was seen in women with the healthiest diet (HR [95%CI] 2.46 [1.18–5.14], ref. least healthy) whereas higher levels of physical activity were significantly associated with slower initiation of antihypertensives in women (HR [95%CI], moderate; 0.51 [0.30–0.88]), high; 0.48 [0.30–0.77], ref. low). Neither diet nor physical activity levels affected initiation of lipid-lowering medicines in women, and lifestyle factors were not associated with initiation of antihypertensives or lipid-lowering medicines in men.

Conclusions: Relationships between lifestyle and medicine initiation varies with health behavior, drug-class, and sex. Regarding diet, initiation of antihypertensives in women may agree with a healthy adherer effect, whereas for physical activity, the association appear inverse. Diet and physical activity levels are less influential for initiation in men, and for lipid-lowering medicines. As findings are uncertain, further studies are needed to clarify relationships between these factors.

Trial registration: VIPVIZA-trial registration number: NCT01849575, registration date: 2013-05-08.