Author Identifier (ORCID)
Nicola P. Bondonno’s ORCID record 
Benjamin H. Parmenter’s ORCID record
Jonathan Hodgson’s ORCID record
Lauren C. Blekkenhorst’s ORCID record
Catherine P. Bondonno’s ORCID record
Cassandra Smith’s ORCID record
Abstract
Background and aims: Abdominal aortic calcification (AAC) reflects subclinical atherosclerotic cardiovascular disease (ASCVD), but its lifestyle determinants remain uncertain. We investigated how a Healthy Lifestyle Score (HLS) relates to AAC and whether AAC mediates the HLS-ASCVD association. Methods and results: Participants from the UK Biobank Imaging study were assessed for AAC from DXA images. A Healthy Lifestyle Score (HLS), based on smoking, physical activity, diet quality, alcohol consumption, sleep, and BMI was developed, and categorised as low, moderate and high. Cross-sectional associations with (i) any AAC (AAC≥1) and (ii) high AAC (AAC≥6) were analysed using multivariable-adjusted logistic regression models. The association between HLS and incident ASCVD over 6 years was assessed using Cox regression models. Mediation analysis examined the extent to which the HLS-ASCVD association was mediated by AAC. Among 27,818 participants (52% female; median age 65y), 33.5% had any AAC and 4.4% had high AAC. Compared to participants with a low HLS, those with moderate or high scores had 21% (95%CI: 60%-105%) and 66% (33%-59%) lower odds of having high AAC, respectively, and 10% (78%-104%) and 18% (0.71%-95%) lower odds of having any AAC, respectively. These associations were strongest in women and those younger than 65 years. During follow-up, a one-point increment in the HLS was associated with a 4% (0%-8%) lower rate of incident ASCVD. High AAC accounted for 20% (10%-48%) of this association. Conclusion: These findings suggest targeting specific modifiable lifestyle factors, especially earlier in life, may help prevent high AAC levels and subsequent risk of ASCVD.
Keywords
aortovascular disease, DXA, subclinical cardiovascular disease, vascular calcification
Document Type
Journal Article
Date of Publication
1-1-2026
Article Number
104843
ISSN
09394753
Publication Title
Nutrition, Metabolism and Cardiovascular Diseases
Publisher
Elsevier
School
Centre for Artificial Intelligence and Machine Learning (CAIML) / School of Science / Nutrition and Health Innovation Research Institute
RAS ID
95336
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Bondonno, N. P., Gebre, A. K., Parmenter, B. H., Hodgson, J., Blekkenhorst, L. C., Bondonno, C. P., Woodman, R., Kemp, J. P., Webster, J., Schultz, C., Smith, C., Saleem, A., Gilani, S. Z., Duncan, E. L., Hung, J., Lim, W. H., Raina, P., Schousboe, J. T., Harvey, N. C., . . . Lewis, J. R. (2026). Associations between modifiable lifestyle risk factors and abdominal aortic calcification in the UK Biobank Imaging Study. Nutrition, Metabolism and Cardiovascular Diseases. Advance online publication. https://doi.org/10.1016/j.numecd.2026.104843